Subjective Experience of Illness Among Adolescents and Young Adults With Diabetes: A Qualitative Research Study

Diabetes mellitus type 1 is a chronic illness that has its onset in childhood or adolescence. It is determined by the insufficient production of insulin. The main therapies consist of replacement of the lacking insulin, diet, exercise, and glycemic control. If treatment is managed by parents in childhood, adherence seems to be a difficult issue during adolescence. In order to understand the subjective experience of the illness and treatment, the present study aims to investigate the patients' subjective perspective by addressing a group of adolescents and young adults in pediatric care. A qualitative research design was adopted with semi-structured interviews, and later software thematic analysis was performed. Six core issues were deepened: family and health-care professional's mediation support for self-management, adherence to treatments as a boring responsibility, disclosure problems in peer relationships, difficulty in becoming autonomous in a period of socioeconomic crisis, illness as concern for the future, and seeking a normal life in daily activities. The knowledge can be useful for designing more appropriate interventions that favor the active engagement of patients.

Risky consumption, reasons for use, migratory status and normalization: the results of an Italian study on minors aged between 13 and 16

Purpose

The purpose of this paper is to describe the relationship between migratory status, the use of legal and illegal psychoactive substances and psychological disorders perceived in a sample of minors.

Design/methodology/approach

A transversal multicentre study was carried out with interviews with young people aged 13-16 years recruited from middle and high schools in Italy.

Findings

The results show the implementation of a process of normalization in terms of the presence of legal and illegal psychoactive substances in the living contexts of the minors, of their widespread early use and of a substantial indifferentiation in the reasons for use (e.g. pleasure, curiosity, fun). Youths born in Italy with at least one non-native parent are noteworthy for an elevated prevalence of perceived psychological disorders and for particular lifestyles linked to the use of marijuana, alcohol abuse and the intensive consumption of tobacco. Second-generation minors show symptoms of psychological malaise, anxiety and depression before which the use of substances appears to realize a particular form of self-cure.

Research limitations/implications

This study presents some objective limits that indicate prudence in generalizing the results: only those who obtained consent from their parents were interviewed and the information communicated in the interviews could have been influenced by various factors, including the situation and the location. The authors used a standard definition of binge-drinking (Valencia-Martín et al., 2008). Actually, different criteria (i.e. number of drinks, time of consumption, etc.) and formulations of the question are used in different surveys, showing that there is as yet no consensus definition of binge-drinking. Nevertheless, the term has become somewhat confusing as it is often used as a synonym of drunkenness, making cross-cultural comparisons difficult (Beccaria et al., 2014). These are aspects that limit the generalizability of the results to the interviews alone and do not allow for prevalence estimates. Nevertheless, the results offer useful indications for future prevention projects specifically oriented to early adolescence.

Practical implications

The results of the study, on the one hand, document the growing use of legal and illegal proactive substances among minors and the relative cultural trend in this particular age band, testified to by the high number of those who have been present in situations of consumption to whom the substances were offered; on the other, they evidence a subpopulation of youths born in Italy with at least one non-native parent (i.e. second generation of immigrants). These youths stand out for an elevated prevalence of perceived psychological disorders and for their particular lifestyles connected to the use of marijuana, alcohol abuse and the intensive consumption of alcohol. This is also the group with the highest percentage of mothers alone in the family.

Social implications

A group of adolescents living in a monoparental family, that is, with the mother alone emerges, and as the literature has shown, family structure and poverty are linked (Landale et al., 2011; Svensson and Hagquist, 2009). In fact, such mothers, even those with a high level of education, are mostly unemployed. Adolescents with a single parent often not only face resource deficits but also other risk factors, such as high family stress, inadequate supervision, multiple family transitions and frequent residential moves. Specifically, these second-generation adolescents are female and they manifest sensation-seeking behaviours, but without drug abuse.

Originality/value

The results of the study show new and little-known aspects of the multicultural Italian society that is changing profoundly that should be explored in more detail by targeted research that also focussed on structural factors relatable to specific social positions. In this framework, a particular subgroup, i.e. the second-generation minors, shows symptoms of psychic malaise, anxiety and depression in terms of which substance use seems to realize a form of self-cure.

Shared topics on the experience of people with haemophilia living in the UK and the USA and the influence of individual and contextual variables: Results from the HERO qualitative study

The study illuminates the subjective experience of haemophilia in people who took part in the Haemophilia Experience, Results and Opportunities (HERO) initiative, a quali-quantitative research program aimed at exploring psychosocial issues concerning this illness around the world. Applying a bottom-up analytic process with the help of software for textual data, we investigated 19 interviews in order to describe the core themes and the latent factors of speech, to explore the role of different variables in shaping the participants' illness experiences. The five themes detected are feeling different from others, body pain, acquisition of knowledge and resources, family history, and integration of care practices in everyday life. We illustrate how nationality, age, family situation, the use of prophylaxis or on-demand treatment, and the presence of human immunodeficiency virus or hepatitis C virus affect the experience of our participants in different ways. Findings are used to bring insights on research, clinical practice, and psychosocial support.

The importance of educating subjects entitled to use an adrenaline auto-injector for self-administration

An educational program, consisting in a clear explanation of the technical aspects and use of the adrenaline auto-injection devices (AAD) and in a practical test utilizing a demonstration kit was given to 350 patients from our outpatient clinic. AAD was also distributed to 50 patients formerly followed by another allergy clinic without training. At practical control test, only 10% of the untrained patients where able to correctly use the AAD versus 80% of trained subjects. Since AAD is a life-saving procedure in severe anaphylactic episodes, this attempt to improve the ability of the patient to comply with the procedure can improve the efficacy of the treatment and eventually the patient's health.

Prevalence and incidence of reactions to insect stings in children: a reappraisal

AIM

The prevalence of systemic reactions (SR) to Hymenoptera stings in children was estimated in values lower than 1% in early studies but much higher in recent surveys. We evaluated the current prevalence and the incidence of SR and large local reactions (LLR) to Hymenoptera stings in children in Italy.

METHODS

The data on children were collected from the database of the population study on the city of Cotignola, analyzing the answers to the part of the questionnaire about Hymenoptera stings, that concerned if the subject was ever stung by apids or vespids, if there has been a SR or a LLR, and if subjects with reactions received a diagnostic evaluation and a medical treatment.

RESULTS

Of the population of 1035 children, 173 (16.7%) were stung at least one time by Hymenoptera. Of them, 5 had had a SR and 9 had had a LLR. This defines a prevalence of SR of 0.5% and of LLR of 0.9%. Only one reaction was severe. Of the 14 subjects with SR or LLR, 5 (35.7%) underwent a diagnostic evaluation and one (7.1%) was treated with venom immunotherapy. The incidence of SR in the subsequent 2 years was 0.09% in the first year and 0.08% in the second year.

CONCLUSIONS

These findings do not confirm the recent reports of an increased prevalence of Hymenoptera venom allergy in children. The incidence of SR to stings, thus far unreported for children, was very low both in the first and in the second year.

Allergy to beer in LTP-sensitized patients: beers are not all the same

BACKGROUND

Most cases of beer allergy reported so far have been associated with hypersensitivity to the non-specific lipid transfer protein (LTP). In view of the marked differences in brewing processes we assessed IgE reactivity as well as tolerance to many different beers in an allergic patient.

METHODS

A 45 year-old man hypersensitive to grass pollen, cat dander and Alternaria tenuis with a history of urticaria and dyspnoea after drinking beer and a weak skin reactivity to commercial corn extract was studied. The patient underwent SPT with 36 different brands of beer and an open challenge with those scoring negative was performed. An immunoblot analysis was carried out using 2 SPT-positive beers, 2 SPT-negative beers, and barley, wheat, and maize extracts using both patient's serum and a maize LTP-specific in-house developed polyclonal antibody from rabbit. Further, the immune reactive LTP of one beer was separated by HPLC and the chromatogram was compared to that of purified maize LTP.

RESULTS

Beer SPT scored positive in 30/36 cases. The immunoblot analysis showed IgE reactivity at about 10 kDa against the two SPT-positive beers and against maize with both patient's serum and the polyclonal anti-LTP rabbit serum, whereas the two SPT-negative beers, and barley extract scored negative. The immunodetected protein co-migrated with maize LTP.

CONCLUSION

In beer-allergic patients the diagnostic workup may point to the detection of some tolerated products that can be consumed risk-free.

Fever of unknown origin as unique symptom of an indolent mastocytosis

A 39-years-old man afferred to our hospital for a fever lasting for more than 6 months, without abnormalities at physical examination (in particular no skin alterations); a recent laboratory and instrumental investigation was ineffective and so a fever of unknown origin (FUO) was diagnosed Since he reported an history of infantile mastocytosis (usually auto-resolving) we evaluated his serum-tryptase levels that resulted of 49 ug/L (normal value 20 ug/L), raising the doubt of the presence of an active mastocytosis. The following bone marrow evaluation showed aggregates of CD117 positive cells and a c-Kit point mutation at codon D 816V confirming the diagnosis of indolent mastocytosis.The present case confirm that FUO can be caused by an otherwise asymptomatic indolent mastocytosis, thus suggesting to include the serum-tryptase level measurement in the diagnostic approach to this pathological condition, at least in selected cases.

Prevalence of allergic disorders in Italy: the Cotignola population study

BACKGROUND

The worldwide prevalence of allergic diseases such as rhinitis, asthma, and atopic dermatitis is continuously increasing, while other allergic disorders such as urticaria and angioedema are less investigated. We performed a population study evaluating the prevalence of any kind of allergic disorders.

METHODS

The entire population of 7,201 inhabitants of Cotignola (Ravenna, Italy) was surveyed by a questionnaire assessing symptoms related to rhinitis, asthma, anaphylaxis, skin symptoms and insect sting allergy as well as the features of clinical presentations, diagnosis, and treatment received.

RESULTS

Valid questionnaires were obtained by 6,676 inhabitants (92.7%). The sample was formed by 3,266 males and 3,495 females, the mean age was 45.6 years; 1,035 subjects (15.5%) were aged less than 18 years; 404 subjects (6%) had at least one episode of wheezing/breathlessness in their lifetime, and 243 of them (60.1%) had a diagnosis of asthma; 1,002 subjects (14.8%) had nose symptoms in their lifetime, and 375 of them (37.4%) had a diagnosis of allergic rhinitis or rhinoconjunctivitis. For other allergic manifestations, data were obtained from 5,730 subjects; of them, 178 (3.1%) had skin symptoms, 59 (1.1%) had oral symptoms, and 37 (0.6%) had anaphylaxis; 207 (3.6%) had reactions to insect stings. There were no significant differences in prevalence between Italians and immigrants. Only 51.7% of subjects with asthma, 46.5% of those with rhinitis, 22.7% of those with other allergies, but 97.1% of those with insect allergy, received treatment.

CONCLUSIONS

These findings confirm recent data on epidemiology of allergic diseases in Europe, particularly in Italy, and add some details on how such diseases are managed.

Process of normalization in families with children affected by hemophilia

To understand the normalization process in families with hemophiliac children, and to explore the impact of two different therapeutic regimes on it (on-demand therapy and prophylaxis), we conducted a two-phase study using semistructured interviews. In the course of the first phase, we interviewed 13 parents belonging to 10 families with hemophiliac children in on-demand therapy. In the second phase, 5 years later, we repeated the interviews with three families who began prophylaxis at different times. We analyzed the interviews using text analysis software. The results show very different representations of hemophilia and daily life. Normalization processes involve the overcoming of a divided conception of life, and encourage the integration of care practices within daily life. Moreover, in our article we suggest that although prophylaxis facilitates the recovery of a regular family routine, it alone cannot produce normalization.

Shrimp allergy in Italian adults: a multicenter study showing a high prevalence of sensitivity to novel high molecular weight allergens

BACKGROUND

Shrimp is a frequent cause of food allergy worldwide. Besides tropomyosin, several allergens have been described recently.

OBJECTIVE

We investigated which allergens are involved in Italian shrimp-allergic adults.

METHODS

Sera from 116 shrimp-allergic patients selected in 14 Italian allergy centers were studied. Skin prick tests with house dust mite (HDM) as well as measurements of IgE to Pen a 1 (shrimp tropomyosin) and whole shrimp extract were performed. All sera underwent shrimp immunoblot analysis, and inhibition experiments using HDM extract as inhibitor were carried out on some Pen a 1-negative sera.

RESULTS

Immunoblots showed much variability. IgE reactivity at about 30 kDa (tropomyosin) was found in <50% of cases, and reactivity at about 67 kDa and >90 kDa was frequent. Further reactivities at 14-18, 25, 43-50, about 60 and about 80 kDa were detected. Most subjects had a history of shrimp-induced systemic symptoms irrespective of the relevant allergen protein. IgE to Pen a 1 were detected in sera from 46 (41%) patients. Skin reactivity to HDM was found in 43/61 (70%) Pen 1-negative subjects and inhibition studies showed that pre-adsorption of sera with HDM extract induced a marked weakening of the signal at >67 kDa.

CONCLUSIONS

Several allergens other than tropomyosin are involved in shrimp allergy in adult Italian patients. Some hitherto not described high molecular weight allergens seem particularly relevant in this population and their cross-reactivity with HDM allergens makes them novel potential panallergens of invertebrates.

A case of anaphylaxis: horse-fly or hymenoptera sting?

In literature it has been described a high risk of systemic reaction after blood-sucking Dyptera bites, like mosquitoes and horsefly, in people sensitive to hymenoptera. A 51 year old man, allergic to hymenoptera venom and with a history of i.v. reaction after Mueller, who has been treated with Vespula sp. ITS for the last 3 years, was stung by a yellow, black and green insect on the neck. Five minutes after the bite, he suffered generalized hitching and urticaria, oral cavity and lower limbs paresthesia, followed by lost of consciousness. At the Emergency Room he was successfully treated with adrenaline, intravenous antihistamines and corticosteroid. The description of the insect as well as the lack of the sting on the site suggested a wasp as the culprit. By studying one of these insect that has been captured by the patient, it turned out it wasn't a Vespula, but a horsefly, the Tabanus bovinus, which resembles Hymenoptera. Skin prick test and RAST for Tabanus confirmed the allergology diagnosis. In conclusion, also Tabanus bovines can cause systemic reaction up to anaphylactic shock.

Social Representations of Rights and Duties in Young Italians and Albanians

Rights and duties are normative social representations that organize social interactions. In this article, representations of rights and duties were analyzed in Italy and Albania, focusing on their social anchoring in culture and values. Italians underlined the priority of their individual rights over duties to others. Conversely, Albanians defined rights as focusing on the protection of fundamental individual freedoms and defined duties emphasizing the responsibilities of the individual and the family. The anchoring in value-types shows that people who attach importance to individualistic values conceived of rights in a self-centered manner, while those who attach importance to egalitarian values underscored their personal responsibilities in rights and duties.

The wasp-horsefly syndrome

Here are two cases of two male patients of 57 and 62 years of age, already known as allergic to stinging hymenoptera venom, who after a horsefly bite have presented a serious 3-4 degree-type Mueller classification systemic reaction. The diagnosis has been carried out clinically and after an accurate environmental anamnesis and along with prick tests and RAST, further specific entomological confirm. In literature the so called wasp-mosquito-syndrome has been indicated where hyaluronidase has been referred to as the cross allergen, between the hymenoptera venom and the mosquito saliva, which likely triggers the reaction. We believe that it is also possible to take into consideration a wasp-horsefly-syndrome as well, supposing the increased risk of anaphylactic reactions to Tabanidae bites, relatively frequent in areas with animals and streams, in subjects sensitized to stinging hymenoptera. We also suggest the possibility that in these subjects some systemic reactions are due in fact to Tabanidae bites and not so much for the failure of a possible active ITS of stinging hymenoptera.

Ventricular fibrillation after a hymenoptera sting

A 54-year-old male, who had presented 2 ventricular fibrillation (VF) episodes with post-anoxic coma and later a return to consciousness and to a sinusal rhythm after defibrillation, have been placed a ventricular intracavitary stimulator (AICD). Since all the tests including the coronarygraphy have been found normal, we have paid attention to the anamnesis revealing an Apis mellifera sting before both VF episodes, previously considered irrelevant for the absence of relevant local symptoms. Intracutaneous tests were negative to Vespula sp. and positive to A. mellifera extract at a concentration of 0.01 mug/ml. Specific IgE for A. mellifera venom presented values of 2,36 U/ml for A. mellifera and <0.35 U/ml per Vespula sp. and Polistes dominulus. The patient was then submitted to ITS with A. mellifera aqueous extract. During the RASH treatment no adverse reactions have been observed, whereas we witnessed a major adverse reaction, 3 min after the first 100 mcg maintenance dose, controlled with anti-H1 and cortisone reaction, nevertheless no reactions were observed during the 3 years the same dosage has been repeated monthly. Our case supports the hypothesis of an anaphylactic reaction as trigger of vasoconstriction in individuals affected by ventricular arrhythmia not explained with other causes such as a coronary disease, a myocardiopathy or a pharmacological toxicity. Arrhythmia can be a serious outbreak of a mediated IgE allergic reaction even without any relevant local symptoms. The diagnostics with lyophilized A. mellifera venom has been proven safe in a patient who suffered a cardiac anaphylaxis.

Safety of etoricoxib in patients with reactions to NSAIDs

BACKGROUND

Adverse reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) are a frequently reported problem due to the fact that these molecules are often used for control of pain and inflammation. Although the use of selective inhibitors of cyclooxygenase (COX) 2 helps to prevent some of these adverse reactions, they can have cardiac side effects when taken for prolonged periods. Here we report the safety and tolerability of etoricoxib, a selective COX-2 inhibitor with fewer cardiovascular effects, in patients with adverse reactions to NSAIDs.

PATIENTS AND METHODS

We performed placebo-controlled oral challenge with etoricoxib in 65 patients with previous adverse reactions to NSAIDs: 13 to salicylates, 18 to arylpropionic acids, 10 to arylacetic acid, 12 to oxicam and derivates, 8 to pyrazolones, and 4 to acetaminophen (paracetamol). The reported symptoms were urticaria or angioedema in 69%, rhinitis in 3%, and 1 case of anaphylactic shock (1.5%). The challenge was done using the placebo on the first day, half dosage of etoricoxib (45 mg) on the second day, and the therapeutic dose of 90 mg on the third day. The challenge was done in the outpatient department of the hospital and the subjects were monitored for a further 4 to 6 hours after challenge.

RESULTS

Oral challenge with etoricoxib was well tolerated in 97% of the patients. Only 2 systemic reactions were reported during the challenge test.

CONCLUSION

Etoricoxib can be considered a safe molecule for those patients with previous adverse reactions to NSAIDs.

CD30 serum levels and response to hymenoptera venom immunotherapy

BACKGROUND

The glycoprotein CD30 is expressed and released by T lymphocytes that secrete type 2 helper cytokines of (T(H)2). These molecules play a role in the pathogenesis of allergic diseases. Venom immunotherapy has proven to be very effective in hymenoptera venom allergy through a shift in cytokine production from T(H)2-type cytokines to T(H)1-type cytokines.

OBJECTIVE

To evaluate the relationship between the soluble form of CD30 (sCD30) and venom immunotherapy in patients with hymenoptera venom allergy.

MATERIALS AND METHODS

sCD30 levels were assayed by enzyme-linked immunosorbent assay in the sera of 61 healthy controls and 14 patients with hymenoptera venom allergy who had undergone immunotherapy before treatment and 1,3, and 12 months after treatment started. Nine patients were allergic to Apis venom, 4 to Vespula venom, and 1 to Polistes venom.

RESULTS

CD30 serum levels (median, interquartile range) were significantly higher in venom-allergic patients before treatment (33.6 U/mL; 14.8-61.6) than in controls (9.7 U/mL, 1.9-21.3) (P < .000). These levels decreased progressively during treatment in all patients except 2 (P < .000). At the third month of therapy, the levels reached statistical significance in comparison with baseline.

CONCLUSIONS

This study shows that sCD30 levels are significantly higher in patients with hymenoptera venom allergy and indirectly confirms a preferential T(H)2-type cytokine production in these patients. sCD30 expression decreases during immunotherapy, thus confirming the immunomodulatory role of this treatment in promoting a shift to T(H)1-type cytokines.

Efficacy, safety, and modulation of immunologic markers by immunotherapy with honeybee venom: comparison of standardized quality depot versus aqueous extract

Venom immunotherapy (IT) is a very effective method for the treatment of Hymenoptera venom allergy. We compared safety, efficacy, and modulation of specific immunologic parameters in 70 patients sensitized to Apis mellifera, treated for > or = 5 years with standardized quality (SQ) aqueous IT, either with a rush (n = 20) or with a cluster (n = 20) induction protocol, or with an SQ depot extract and a cluster induction protocol (n = 30). We made an open, noncontrolled study. Side effects were monitored and the effects of field stings during the maintenance phase of the treatment and after its interruption were recorded. Skin reactivity to Apis was measured by end point dilution and specific serum immunoglobulin E (IgE) were measured by a solid-phase-based assay. The depot IT was better tolerated than aqueous IT with rush induction. This was caused by mainly the lower frequency in the induction phase of systemic side effects (3.4% versus 36.8% [p < 0.0041] on a "per patient" and 0.1% versus 0.9% [p = 0.0092] on a "per dose "basis, respectively). The cluster protocol with the aqueous extract tended to be better tolerated that the rush protocol. About one-half of patients from each group were re-stung during the study and all suffered only minor discomfort. Reduction of skin reactivity and of serum-specific IgE was significant in the three groups (p < 0.02 in all cases). SQ Depot IT to Apis venom allergy administered with a cluster protocol induces less side effects and is equally effective then IT with SQ aqueous extract administered with a rush protocol.

Focal nodular hyperplasia after busulfan treatment

The case of a 48-year-old woman in whom focal nodular hyperplasia of the liver developed after busulfan therapy was administered for essential thrombocytosis is described. Focal nodular hyperplasia is a reactive disorder related to a circulation disorder. The close temporal relation between the haematological disease, busulfan treatment and the appearance of hyperplastic diseases of the liver in our patient supports the possibility that the association of the events might not be casual.

Anaphylactic shock to Argas reflexus bite

Anaphylaxis is a severe, life-threatening allergic reaction, affecting both children and adults. The occurrence of anaphylaxis is not as rare as generally believed (1.21% to 15.04% of the US population). Often the cause of this reaction remain unknown, mainly due to the difficulty in defining the outbreaking causes. Herein, we describe an interesting case of a patient, who developed an anaphylactic reaction after the bite of a pigeon tick. During the last 2 years, in wintertime, the patient often came to the emergency room for general rash and swelling, hypotension and tachycardia preceded by itching and general distress. Notably, the symptoms manifested themselves as night fell. In two particular occasions the patient reached the hospital in a state of shock. After another episode of general swelling, the patient was invited to examine her domestic environment. She brought us some parasites, collected at home, particularly on the bed. A morphological examination by entomologists proved these parasites to belong to Argas reflexus (Arg.r.), one of the 31 species of soft ticks. The presence of specific IgE to a protein secreted by the Arg.r. salivary glands was in favour of immediate-type systemic reaction, as supposed by the clinical history.

Effects of hydroclimatic anomalies on bacteriological quality of the Middle Paraná River (Santa Fe, Argentina)

Lenitic and lotic aquatic environments were studied in the Middle Paraná River basin, one of the largest rivers of the world (basin: 1,510,000 km2, length: 2,570 km). The Paraná River (S 31 degrees 42' 04"; W 60 degrees 29' 39"), during El Niño-Southern Oscillation (ENSO) (1997-1998), registered maximum flows of 29,962 m3 s(-1) (more than twice the mean flow) and also positive pluvial anomalies (A) (from +120 mm to +161 mm). However, concentrations of Escherichia coli remained low, with values similar to the mean (p > 0.05) (1.3802 log10cfu/100 ml). Only a maximum peak (1.903 log10cfu/100 ml), significantly higher than the mean (p < 0.0001), was detected during the ascending phase of the flood pulse. During La Niña (September 1999-March 2000; Q = 11,255 m3 s(-1); A = -78 mm to -84 mm), concentrations of E. coli were significantly lower than the mean (p < 0.0001). During the post-Niña period, with normal flows (Q = 14,900 m3 s(-1)) but with strong positive pluvial anomalies (A = +118 mm to +377 mm), the fecal indicator density reached maximum values (up to 2.699 log10cfu/100 ml, p < 0.0001). The multiple regression model used with all the results obtained in the Paraná River showed that variations in concentrations of E. coli are mainly explained by pluvial precipitations and hydrometric level (p = 0.001). Temporal patterns of concentrations of E. coli in a small, secondary course (Q = 101 m3 s(-1)) followed those of the Paraná River, but concentrations and peaks of E. coli produced by exceptional rains showed a higher magnitude (maximum: 3.325 log10cfu/100 ml). In the floodplain lakes, away from urban centers, concentrations of E. coli were not associated to hydroclimatic anomalies, but directly to vegetable cover: maximum concentrations were always registered during periods that lakes remained covered by floating macrophytes (mainly Eichhornia crassipes); on the contrary, minimum concentrations were registered during periods without vegetable cover.

Anaphylactic reaction to cinoxacin: report of one case associated with inferior acute myocardial infarction

Cinoxacin is an oral synthetic antibacterial agent, of the second generation quinolones group, with excellent efficacy in respiratory, intra-abdominal, pelvic, and skin and soft tissue infections. Overall, quinolones are well tolerated drugs, although phototoxicity and photoallergenicity is well demonstrated experimentally. In this report we show you a case of a man who presented a anaphylactic reaction associated with myocardial infarction, after taking a capsule of cinoxacin. We suppose that there is a direct participation of the heart in anaphylactic reactions, because acttivated mast-cells mediators can determine cardiovascular effects. Then performed double-blind placebo controlled challenge test with an alternative drug. We did not observe any adverse immediate or late adverse reaction to this drug.

[Prediction of the bacteriological quality of natural waters in urban environments. Effect of the El Niño-Southern Oscillation]

At the moment of examination, the bacteriological quality of water is not, to a large extent, more than an a posteriori evaluation: the population is advised afterwards that it had been exposed to a sanitary risk. The ideal situation for managing aquatic environments or recreational use would be to be able to predict at any moment their bacteriological quality. An approach would be to develop predictive models to relate the exceedance (number of days during which the bacteriological indicator exceeds the standards) with environmental variables. Studies were carried out at two beaches with different limnological characteristics, a fluvial beach and a lacustrine beach, from the beginning of 1998 to the end of 2000, so that it was possible to obtain information on the impact of very different hydroclimatic situations on microorganisms of sanitary interest (Escherichia coli and cyanobacteria). Three variables, maximum concentration of E. coli, rains and water level, justified 92.6% of the exceedance variance in the multiple regression model at the fluvial beach. Other abiotic variables (temperature, pH, conductivity, transparency and dissolved oxygen) showed collinearity problems or did not make statistically significant contributions to the model. During the El Niño event (gauge heights > 5 m) there were no exceedances after the rains, even with precipitations of 200 mm. Moreover, cyanobacteria density remained low (x = 1.191 +/- 0.703 log10 cian./ml). During the negative pluvial anomalies, although the exceedances of E. coli were not very frequent at both beaches due to the scarce rains, a massive development of cyanobacteria was produced (x = 4.657 +/- 0.578 log10 cian./ml) at the lacustrine beach. At this beach, the mean decay coefficient (K) for E. coli was significantly (p < 0.05) lower than that estimated for the fluvial beach (K = -0.682 +/- 0.32 versus K = -0.387 +/- 0.16, respectively), possibly due to the unfavourable environment created by the higher development of photosynthetic organisms. Analizing separately the anomalous period, variables that better explained (98.6%) the exceedances were (in addition to the maximum concentration of E. coli) pH, temperature and days without rains (DWR) before the sampling. The longest exceedances (6 to 8 days) were produced at the end of the negative pluvial anomalies, after prolonged periods (> 30 days) of droughts. Regression models obtained to predict the exceedance of E. coli were simplified using only three abiotic variables (water level, rains and DWR). Although, in this way, the percentage of explanation of the exceedance is lower (78.5%), the information needed for the model is obtained quickly and preventive measures can be carried out immediately while waiting for more information.

[Escherichia coli: diversity of biochemical phenotypes in aquatic environments (Santa, Fe, Argentina)]

During certain environmental conditions, the floating aquatic vegetation, mainly represented by Eichhornia crassipes (water hyacinth) invade and even cover water courses assigned to recreational activities or to the supply of drinkable water. The rhizosphere of these plants constitutes an unknown biotope of bacteria of sanitary interest, possibly different from waters without vegetation and of the sediment of the same aquatic system. To verify such possibility, 206 isolated strains in MacConkey Agar (Difco) were typified and identified (78 from water, 65 from sediment and 63 from rhizosphere) using the API 20 E system (v. 4.0) and Apilab plus software (v 3.3.3), both of bioMérieux (Marcy-l'Etoile, France, 1998). Nineteen different biochemical phenotypes from E. coli were found. The 79% of the population belonged to only 7 phenotypes; the 21% remaining, to the other 12 phenotypes. Twelve phenotypes did not share the biotopes, while only 4 were in the three. These results (and those obtained by other authors who used the API 20 E system in other biotopes) suggest that it would be possible to characterize the rhizosphere using those phenotypes that are found in smaller proportion. The greatest index of diversity (H) and evenness (E) were found in the rhizosphere (H = 2.903; E = 0.874). The dendrogram (average distances and UPGMA method) reaffirms the dissimilarity in biochemical phenotypes of E. coli populations of the rhizosphere with regard to the other biotopes. The most abundant bacterial species in the three biotopes were E. coli, Klebsiella terrigena and K. pneumoniae, corresponding to 75.2% of the community. The rhizosphere differed from Serratia odorifera and from Klebsiella spp. because of its higher rate of isolation.

[Temporal and spatial variations of coliforms and Escherichia coli in fluvial recreational waters (Salado River, Santa Fe, Argentina). Relationship with the quality standards]

There are no standards accepted by all the countries to fix top concentrations of microbiological indicators in recreational waters. Even now there is still a considerable discussion either in USA as in Europe. The universal application of a bacteriological quality criterion is hard due to several environmental factors that affect the relation between the indicator, the exposition and the health risks. Our purpose was to present a case study as an example of the influence of the climatic conditions in the application of the most known standards (Environmental Protection Agency of USA, Council of European Communities, World Organization of Health, and others from Canada, South Africa and Hong Kong). The pluvial rainfall increased the number of E. coli, thermotolerant coliforms (C Te), and total coliforms (CT) 6-10 fold, in comparison to the number registered during the steady-state conditions of the system. However, not all the standards included that factor. In Summer, hourly, daily and weekly variations were proved, therefore the standards that suggest fortnightly sampling frequencies would not be convenient in that system. Although the main source of variation was time, spatial variability was also detected. The percentage of E. coli among the C Te was very variable, but the average resulted low (26%) compared to the levels in temperate regions of other countries (> 90%). According to the directives proposed by the Commission of European Communities, the parameter has been changed (C Te for E. coli), but the standard has remained (2000/100 ml). Thus, the directive would be more permissive.

[Bacteriological quality of Bendetti Lake (Santo Tomé, Santa Fe Province, Argentina) and associated environmental variables]

The main objective was to determine the bacteriological quality of a shallow lake in the lower Salado River Basin (Bedetti, 31 degrees 40' S and 60 degrees 45' W). Seventy samples were tested by the most probable number (MPN) method, throughout three years. The number of thermotolerant coliforms was very variable: from 20 MPN/100 ml to 130,000 MPN/100 ml. These variations were mainly associated to the local rains (rs = 0.4853, p = 0.0001) and to the hydrometric level-h-(rs = 0.3835, p = 0.008). Statistically significant correlations between coliform bacteria and other variables (temperature, oxygen, pH, conductivity and transparency) were not found. The increase of coliforms associated to the increase of the hydrometric level indicates the presence of diffuse contamination sources. It was found that the rains affected the bacteriological quality, specially during the low water periods (h < 3.60). During the high water periods (h > 4.70) one of the main coliform contributor was represented by the incoming floating islans and aquatic macrophyte, from allochthonous fluvial systems. The coliform concentrations between the Bedetti lake and the Salado river were compared. The results show a better bacteriological quality of the lake (geometric average = 1,990/100 ml vs. 420/100 ml, n = 56) so that, connecting them by the construction of an artificial channel is not advisable.

[Frequency of vibrio cholerae isolation from water and plankton of the lower Salado river basin (Santa Fe, Argentina)]

In the lower Salado River Basin 85 samples of water and 40 of plankton were collected from January 1993 to December 1996. In the 69.4% of the water samples and in the 75% of the plankton samples Vibrio cholerae was detected. None of the isolate strains belonged to O1 and O139 serogroups. The seasonality in the frequency of isolation of V. cholerae tested by multiple proportions comparison test was not confirmed (p > 0.05). There were significant differences (p < 0.05) between the isolation frequencies found in the Salado River (85 samples, 69.4%) and those found in the Paraná River environments (16 samples, 25%) and in municipal waste effluents (18 samples, 33.3%).