Food contamination and cardiovascular disease: a narrative review

Cardiovascular disease is a significant cause of morbidity and mortality among non-communicable diseases worldwide. Evidence shows that a healthy dietary pattern positively influences many risk factors of cardiometabolic health, stroke, and heart disease, supported by the effectiveness of healthy diet and lifestyles for the prevention of CVD. High quality and safety of foods are prerequisites to ensuring food security and beneficial effects. Contaminants can be present in foods mainly because of contamination from environmental sources (water, air, or soil pollution), or artificially introduced by the human. Moreover, the cross-contamination or formation during food processing, food packaging, presence or contamination by natural toxins, or use of unapproved food additives and adulterants. Numerous studies reported the association between food contaminants and cardiovascular risk by demonstrating that (1) the cross-contamination or artificial sweeteners, additives, and adulterants in food processing can be the cause of the risk for major adverse cardiovascular events and (2) environmental factors, such as heavy metals and chemical products can be also significant contributors to food contamination with a negative impact on cardiovascular systems. Furthermore, oxidative stress can be a common mechanism that mediates food contamination-associated CVDs as substantiated by studies showing impaired oxidative stress biomarkers after exposure to food contaminants.This narrative review summarizes the data suggesting how food contaminants may elicit artery injury and proposing oxidative stress as a mediator of cardiovascular damage.

Proposal of model for personalized early adapted cancer screening in people living with HIV: experience of "Gaetano Martino" Hospital University of Messina

Human immunodeficiency virus (HIV) infection has historically been related to the development of specific cancers, some of which are so closely linked to the infection, such as Kaposi's Sarcoma (KS), that they have earned the name Acquired Immuno-Deficiency Syndrome (AIDS)-defining cancers (ADCs). While the development of antiretroviral therapy (ART) has decreased the incidence of AIDS-defining cancers, the resulting aging of people living with HIV (PLWH) highlighted an increased occurrence of other forms of cancer. At the "Gaetano Martino" hospital in Messina, we developed a multidisciplinary approach by creating a bridge between the Oncology Unit and the Infectious Diseases Unit to carry out screening and a more rapid diagnostic and therapeutic journey for cancers in PLWH. The goal is to improve the diagnosis of various types of cancer by involving other professionals, such as gastroenterologists and gynecologists, to ensure faster access to treatment and, therefore, a greater chance of survival. In addition, our multidisciplinary approach has also included vaccine screening, offered by the "Gaetano Martino" hospital and useful for preventing the development of specific forms of cancer in the entire population and particularly in PLWH.

COVID-19 and acute heart failure among patients with cancer

Background

Patients with cancer represent a uniquely vulnerable population not only with higher susceptibility to COVID-19 but also at increased risk for death. However, detailed information on causes of death and the contribution of pre-existing health conditions to death yet is missing.

Purpose

This study focuses on the implications of COVID-19 in the cardiovascular health of patients with cancer by assessing the relation between cancer and de novo acute heart failure (AHF) with in-hospital mortality.

Methods

The initial population consisted of 3968 patients included in the ISACS COVID-19 registry between March 2020 and February 2022. Of these, 546 patients with chronic HF were excluded, leaving a final population of 3422. Patients were divided in two groups according to the presence or absence of a cancer diagnosis at the time of hospitalization for COVID-19. Primary outcomes were incidence of in-hospital mortality or AHF during hospitalization. Association between cancer and outcomes was estimated using multivariable logistic regression analyses. Subsidiary analysis was conducted to evaluate differences between patients with prior vs active cancer.

Results

Of the 3422 patients included in the study, 468 patients had cancer (8.2% active, 5.5% past cancer). Cancer patients were older (68.9±13.4 vs 63.3±15.6, p-value <0.001) and more likely to be female (50.4% vs 39.1%, p-value <0.001). They presented more frequently with a history of chronic obstructive pulmonary disease (12.3% vs 7.6%, p-value = 0.001). When considering outcomes, cancer patients had a significantly higher incidence of in-hospital mortality (27.7% vs 19.2%; p-value <0.001). This despite the presence of a numerically higher mean PiO2/FiO2 (281±108.8 vs 267.05±122.5, p-value = 0.11) on admission and a lower rate of X-ray findings of interstitial pneumonia (60% vs 70.5%, p-value <0.001) than their non-oncological counterparts, as well as similar use of mechanical ventilation (30.6% vs 35.0%, p value=0.14). The association between cancer and death persisted when adjusting for demographic, laboratory findings and in-hospital treatment (OR: 1.46; 95% CI: 1.11–1.94; p value=0.01). Cancer patients also had higher rates of AHF (9.6% vs 4.7%, p-value <0.001) during hospitalization. This association was independent from presence of cardiovascular risk factors or comorbidities (OR: 1.61; 95% CI: 1.07–2.43; p value=0.02). When restricting the analysis to the cancer population, AHF appeared to be significantly associated with death (OR: 2.41; 95% CI 1.18–4.95; p-value = 0.01), but this correlation persisted only in patients affected by active cancer in age and sex adjusted analyses (OR: 4.27; 95% CI: 1.51–12.07; p value=0.01 vs 1.20; 95% CI: 0.38–3.76; p-value = 0.75).

Conclusions

The incidence of AHF in cancer patients with COVID-19 is high. Patients with active cancer are also at high risk for mortality. This has implications for cardiac monitoring and chemotherapy administration during COVID-19.

Funding Acknowledgement

Type of funding sources: None.

An unusual presentation of pulmonary aspergilloma and review of available literature

INTRODUCTION

Aspergilloma is a non-invasive form of pulmonary aspergillosis usually presenting as a clump of mold in pre-existing cavitary lung disease. Aspergillus related lung diseases have been classified into four types, whose manifestation is often related to previous lung diseases and host immunologic status.

CASE REPORT

Cases of cavitary pulmonary aspergillosis without any evidence of pre-existing cavities, are rarely reported. We present here a case of pulmonary aspergillosis in which cavity formation appeared apparently after the establishment of infection.

CONCLUSIONS

The occurrence of atypical presentations and the importance of recognizing these unusual cases of pulmonary aspergilloma is discussed.

AB1294 CO-OCCURRENCE OF IgG4 RELATED DISEASE AND OTHER SYSTEMIC IMMUNO-MEDIATED DISORDERS

Background

IgG4-related disease (IgG4RD) is a fibroinflammatory disease with unique clinical and pathophysiological features. According to the recently released Classification Criteria, the presence of other concomitant immunological disorders (OID) represents an exclusion criterion for the classification of IgG4RD (1). Rigorous application of the Classification Criteria, however, can lead to misdiagnosis because our increasing appraisal of IgG4RD indicates that this condition may coexists with OID (2).

Objectives

To describe IgG4RD presentation in the context of OID.

Methods

IgG4RD was diagnosed based on definitive histological findings. OID were diagnosed based on specific classification/diagnostic criteria.

Results

In six out of 234 (3%) patients IgG4RD occurred in accompaniment with OID, including two patients with sarcoidosis (33%), two with granulomatosis with polyangiitis (33%) one with eosinophilic granulomatosis with polyangiitis (16%) and one with Takayasu arteritis (16%). In three cases IgG4RD preceded OID (Table 1).

Table 1.

*ACR / EULAR 2017 provisional classification criteria for GPA **ACR 1990 Classification criteria for EGPA ***Modified diagnostic criteria for Takayasu arteritis. Shanna et al. 1995. Abbreviations: AZA: Azathioprine; CYC: Cyclophosphamide; EGPA: Eosinophilic Granulomatosis with Polyangiitis; ENG: electroneurography; GPA: Granulomatosis with Polyangiitis; IgG4RD: IgG4 Related Disease; INFX: Infliximab; F: female; M: male; MPDN: Methylprednisolone; MTX: Methotrexate; N: No; PDN: Prednisone; RTX: Rituximab; TCZ: Tocilizumab; Y: Yes

GENDER (Age at IgG4RD diagnosis^)M (56)M (69)F (47)F (51)M (65)F (16)IgG4RDOrgans involvedpancreas, biliary tract, lymphnodes, nasal cavities, skin, ascending aortasalivary glands, pancreas, biliary tract, lungeyelidperiorbital region, lacrimal glandmeninges, abdominal aortaperitoneumACR/EULAR score343620212426Definite histological diagnosisYYYYYY (peritoneal lesion?)(pancreas, lymphnodes)(salivar glands, lung)(eyelid)(periorbiatl tissue, lacrimal gland)(meninges)Induction of remission therapyPDN + AZAPDNAZAPDNPDN + MTXPDN + MTXResponseYYYYYYRelapse (years after treatment)Y (6)Y (10)NY (0,5)Y (5)NSecond line therapyRTXRTX-MPDN + RTXPDN-OTHER IMMUNOLOGICAL DISEASEDiagnosisSarcoidosisSarcoidosisGPAGPAEGPATakayasuOrgans involvedlymphnodes over and infra diaphragmatic, axillary, laterocervical, lumboaortic, inguinal, hepaticpulmonary and over and infradiafragmatic lymphnodestracheal cartilagepulmonary nodules, scleritisrespiratory tract (asthma), skin, peripheral nervous system, blood eosinophilialeft subclavian artery, left common carotid, anonymous artery, thoracic aorta, suprarenal abdominal aorta, right pulmonary arteryClassification criteria fulfilled?not availablenot availableY*Y*Y**Y***Autoantibodynonenonec-ANCAc-ANCAp-ANCAnoneDefinite histological diagnosisY (lymphnode)Y (paratracheal lymphnodes)not availableY (pulmonary nodule)Y (skin biopsy)not availableTiming of diagnosis vs IgG4RDsubsequentpreviouspreviouscontemporarypreviouscontemporaryYears after/before IgG4RD diagnosis2112030TreatmentPDNPDN + MTXPDN + AZAPDNPDN + CYCINFXResponse to treatmentYYYYYN

Conclusion

Our data demonstrate that IgG4RD can occur in overlap with OID, especially granulomatous diseases. Further research is needed to define whether this clinical scenario is associated with different pathological bases and long-term outcomes.

References

[1]Wallace ZS et al., Ann Rheum Dis, 2020

[2]Mizushima I et al., Rheumatology, 2021

Disclosure of Interests

None declared

Role of the innate immune system in host defence against fungal infections

OBJECTIVE

The objective of this narrative review is to present a summary of current knowledge of host-fungal pathogen interaction focusing on the importance of the innate immune system in host defense against invasive fungal infections. In addition, the emergence of drug resistance in the treatment of invasive fungal infections has also been highlighted.

MATERIALS AND METHODS

A literature review was conducted to identify articles documenting the role of the host innate immune system against fungal pathogen and the emergence of drug resistance in the treatment of invasive fungal infections.

RESULTS

In this review, we provide an update from the most recent studies on the role of the host innate immune system against fungal pathogen and we also highlight the mechanisms that these pathogens use to evade the innate immune system.

CONCLUSIONS

This review highlights the existence of different cellular mechanisms that, following the recognition of fungal PAMPS, induce the production of different sets of defense factors. The development of new diagnostic methods and antifungal drugs along with a better understanding of the host immune response are key approaches to controlling invasive fungal infections.

Protective role of IL-18 in host defenses against group B Streptococcus

The aim of this study was to investigate the role of IL-18, a member of the IL-1 family, in group B Streptococcus (GBS) infection. Both in a neonatal and adult model of GBS infection, IL-18-deficient animals were significantly more susceptible to infection than WT animals. The lack of IL18 was associated with a marked reduction in IFN-γ-levels after bacterial stimulation but did not play a significant role in the recruitment of PMN to sites of GBS infection. Collectively, our data document a fundamental function of IL-18 signaling in boosting the host immune responses against GBS infection.

POS1247 CLINICAL FEATURES AND OUTCOMES OF COVID-19 IN PATIENTS WITH IGG4-RELATED DISEASE. A COLLABORATIVE EUROPEAN MULTI-CENTRE STUDY

Background:

Coronavirus disease 2019 (COVID-19) is a pandemic-spread systemic infectious disease with prominent respiratory manifestations and significant associated morbidity and mortality. Elderly people are most significantly affected with mortality ranging from 2.4% (age 60-69) to 19.6% (age>80) in European Countries. The prevalence of COVID-19 and of its complications in patients with immune-mediated disorders, remains unclear. The frequency and impact of COVID-19 on patients with IgG4-related diease (IgG4-RD), many of whom are on concurrent immunosuppression has not been addressed.

Objectives:

To assess the epidemiological and clinical relevance of COVID-19 in patients with IgG4-RD.

Methods:

This is a multi-centre retrospective observational study of IgG4-RD patients from France, Italy, Spain and the United Kingdom. Demographics, comorbidities, IgG4-RD features, current and past treatment along with COVID-19-suggestive symptoms and COVID-19 diagnoses from February 2020 to January 2021 were recorded by means of direct or phone interviews. Patients with reverse-transcriptase polymerase chain reaction-confirmed (cCOVID) or presumed COVID-19 based on clinical, serological or imaging features (pCOVID) were pooled for analysis (totCOVID) and compared to patients who were not diagnosed with COVID-19. Inter-group comparison of categorical and quantitative variables were performed by using the chi-square test with Fisher’s correction and the Mann-Whitney’s test respectively. Data are expressed as median (interquartile range) unless otherwise specified.

Results:

A total of 305 patients [71% males, median age 64 (54-74) years] were studied. Pancreato-biliary disease was the most frequently observed IgG4-RD phenotype (39%). Fifty-one percent of patients were taking corticosteroids at time of interview and 30% were on biological or conventional immunosuppressants. Thirty-two totCOVID cases (23 cCOVID, nine pCOVID) were identified: 11/32 were hospitalised, two needed intensive care and four (13%; 3/4 aged >80 years) died. Having one or more infected family members was a risk factor for COVID-19 in patients with IgG4-RD (OR=19.9; p<0.001). No other demographic, clinical or treatment features associated with COVID-19. In particular there was no association between adverse outcomes with COVID-19 and higher doses of steroids (>20mg) or rituximab administration.

Conclusion:

The prevalence and course of COVID-19 in IgG4-RD patients are similar to those of the general population of the same age, with no evident impact of disease- or treatment-related factors to the basal infectious risk. Effective public health countermeasures might be beneficial for patients with IgG4RD.

References:

[1]European Centre for Disease Prevention and Control (ECDC): https://covid19-surveillance-report.ecdc.europa.eu/

[2]Yang H, Ann Rheum Dis, 2021

Disclosure of Interests:

Giuseppe Alvise Ramirez: None declared, Marco Lanzillotta: None declared, Mikael Ebbo: None declared, Andreu Fernandez-Codina Consultant of: consulting fees from Atheneum Consulting, Gaia Mancuso: None declared, Fernando Martínez-Valle: None declared, Olimpia Orozco-Galvez: None declared, Nicolas Schleinitz: None declared, Lorenzo Dagna Consultant of: Abbvie, Amgen, Biogen, BristolMyers Squibb, Celltrion, Galapagos, GlaxoSmithKline, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI, Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, GlaxoSmithKline,Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi Genzyme, and SOBI, Emma L. Culver: None declared, Emanuel Della Torre: None declared

POS1356 PERSISTENCE OF TFH CELLS AFTER RITUXIMAB IS ASSOCIATED WITH IGG4-RELATED DISEASE RELAPSE

Background:

Clinical improvement after B-cell depletion with rituxmab suggests a prominent pathogenic role of B-lymphcytes in IgG4-related disease (IgG4-RD). IgG4-RD, however, relapses in most cases together with re-expansion of clonally divergent plasmablasts indicating that treatment with rituximab does not completely abrogates T follicular helper (Tfh)-cells dependent germinal center reactions leading to de-novo plasmablast differentiation.

Objectives:

In the present work we aim to study the effects of B-cell depletion therapy with rituximab on circulating Tfh cells and on the levels of CXCL13 - a chemotactic factor for B-lymphocytes produced by Tfh cells - in patients with IgG4-RD.

Methods:

Thirty patients with IgG4-RD, diagnosed according to the “Consensus Statement on the Pathology of IgG4-RD” and fulfilling the “2019 ACR/EULAR Classification Criteria” were included in the present study. Ten patients with relapsing disease were treated with the anti-CD20 monoclonal antibody rituximab (two 1g infuxions 15 days apart). Peripheral blood mononuclear cells and serum were collected before rituximab and three months after infusion. Tfh cells subsets in the peripheral blood were measured by flow cytometry and CXCL13 plasma levels were measured by ELISA assay.

Results:

No changes in total Tfh cells and Tfh cells subsets were observed three months after rituximab neither in absolute counts nor in percentage of CD4+ T cells. In particular, no difference in Tfh1, Tfh2, Tfh17, T follicular regulatory and highly functional Tfh cells counts was observed before and after treatment. The serum level of CXCL13 was significantly higher in active untreated IgG4-RD patients compared to healthy controls (151.94 pg/ml vs 66.98 pg/ml, p value = 0.0026), but was not affected by rituximab treatment (p value = 0.41).

Conclusion:

In relapsing patients with IgG4-RD rituximab does not affect circulating Tfh cells numbers and serum levels of CXCL13. Persistence of Tfh cells after rituximab and reconstitution of germinal center reactions likely drives IgG4-RD flare.

References:

[1]Lanzillotta M, Mancuso G, Della-Torre E. Advances in the diagnosis and management of IgG4 related disease. BMJ. 2020 Jun 16;369:m1067. doi: 10.1136/bmj.m1067. PMID: 32546500.

[2]Lanzillotta M, Della-Torre E, Stone JH. Roles of Plasmablasts and B Cells in IgG4-Related Disease: Implications for Therapy and Early Treatment Outcomes. Curr Top Microbiol Immunol. 2017;401:85-92. doi: 10.1007/82_2016_58. PMID: 28091934.

[3]Campochiaro C, Ramirez GA, Bozzolo EP, Lanzillotta M, Berti A, Baldissera E, Dagna L, Praderio L, Scotti R, Tresoldi M, Roveri L, Mariani A, Balzano G, Castoldi R, Doglioni C, Sabbadini MG, Della-Torre E. IgG4-related disease in Italy: clinical features and outcomes of a large cohort of patients. Scand J Rheumatol. 2016;45(2):135-45. doi: 10.3109/03009742.2015.1055796. Epub 2015 Sep 23. PMID: 26398142.

[4]Mattoo H, Mahajan VS, Della-Torre E, Sekigami Y, Carruthers M, Wallace ZS, Deshpande V, Stone JH, Pillai S. De novo oligoclonal expansions of circulating plasmablasts in active and relapsing IgG4-related disease. J Allergy Clin Immunol. 2014 Sep;134(3):679-87. doi: 10.1016/j.jaci.2014.03.034. Epub 2014 May 6. PMID: 24815737; PMCID: PMC4149918.

Disclosure of Interests:

None declared

The multifaceted spectrum of liver cirrhosis in older hospitalised patients: analysis of the REPOSI registry

BACKGROUND

Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce.

OBJECTIVES

To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties.

METHODS

A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed.

RESULTS

LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT.

CONCLUSIONS

LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features.

Misalignment of hemodynamic forces in the left ventricle is associated with adverse remodeling following STEMI

Funding Acknowledgements

Type of funding sources: None.

Background

Infarct size (IS), area at risk (AAR) and microvascular obstruction (MVO) are well known predictors of adverse remodeling (aLVr) following acute myocardial infarction, while the pathogenic role of left ventricular (LV) hemodynamic forces (HDFs) is still unknown. Recent evidence suggests the role of HDFs in negative remodeling after pathogenic events. 

Purpose

To identify LV HDFs patterns associated with aLVr in reperfused ST-segment elevation MI (STEMI) patients.

Methods

Forty-nine acute STEMI patients underwent CMR at 1 week (baseline) and 4 months (follow-up) after MI.  The following parameters were measured: left ventricular end-diastolic and end-systolic volume index for body surface area (LVEDVi and LVESVi), left ventricular ejection fraction (LVEF) and LV mass index, AAR and IS. LV HDFs were computed at baseline from cine CMR long axis datasets using a novel method based on LV endocardial boundary tracking. LV HDFs were calculated both in apex-base (A-B) and latero-septal (L-S) directions. The distribution of LV HDFs were evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio %). All HDFs parameters are computed over the entire heartbeat, in systole and diastole. aLVr was defined as an absolute increase in LVESV of at least 15% (ΔLV-ESV ≥15%).

Results

Patients with aLVr (n = 18; 37%) had significant greater value of AAR (32 ± 23 vs 22 ± 18; p = 0.03) and slightly larger IS (23 ± 16 vs 15 ± 11; p= 0.07) at baseline. In patients with aLVr at FU, baseline systolic L-S HDF were lower (2.7 ± 0.9 vs 3.6 ± 1; p = 0.027) while diastolic L-S/A-B HDF ratio was significantly higher (28 ± 14 vs 19 ± 6; p = 0.03), reflecting higher grade of diastolic HDFs misalignment. At univariate logistic regression analysis, higher IS [Odd ratio (OR) 1.05; 95% confidence interval (95% CI) 1.01-1.1; p= 0.04] L-S HDFs (OR 0.41; 95% CI 0.2-0.9; p= 0.04] and higher diastolic L-S/A-B HDFs ratio (OR 1.1; 95% CI 1.01-1.2; p= 0.05) were associated with aLVr at FU (Table).  At multivariate logistic regression analysis, L-S/A-B HDF ratio remained the only independent predictor of adverse LV remodeling after correction for other baseline determinants.

Conclusion

Misalignment of diastolic HDFs following STEMI is associated with aLVr observed after 4 months.

Predictors of adverse remodeling Univariate Multivariate Parameter OR (95% CI) P OR (95% CI) P IS (%) 1.05 (1.01-1.1) 0.042 - - Systolic L-S HDF 0.41 (0.2-0.9) 0.04 - - Diastolic L-S/A-B HDF Ratio 1.1 (1.01-1.2) 0.05 1.1 (1.01-1.2) 0.04 A-B:apex-base; L-S: latero-septal; HDFs: hemodynamic forces Abstract Figure. Diastolic HDFs distribution and aLVr

Taxonomic differences in deciduous lower first molar crown outlines of Homo sapiens and Homo neanderthalensis

Recent studies have demonstrated that the outline shapes of deciduous upper and lower second molars and the deciduous upper first molar are useful for diagnosing hominin taxa-especially Homo neanderthalensis and Homo sapiens. Building on these studies, we use geometric morphometric methods to assess the taxonomic significance of the crown outline of the lower first deciduous molar (dm₁). We test whether the crown shape of the dm₁ distinguishes H. neanderthalensis from H. sapiens and explore whether dm₁ crown shape can be used to accurately assign individuals to taxa. Our fossil sample includes 3 early H. sapiens, 7 Upper Paleolithic H. sapiens, and 13 H. neanderthalensis individuals. Our recent human sample includes 103 individuals from Africa, Australia, Europe, South America, and South Asia. Our results indicate that H. neanderthalensis dm₁s cluster fairly tightly and separate well from those of Upper Paleolithic H. sapiens. However, we also found that the range of shapes in the recent human sample completely overlaps the ranges of all fossil samples. Consequently, results of the quadratic discriminant analysis based on the first 8 principal components (PCs) representing more than 90% of the variation were mixed. Lower dm1s were correctly classified in 87.3% of the individuals; the combined H. sapiens sample had greater success (90.2%) in assigning individuals than did the H. neanderthalensis sample (61.5%). When the analysis was run removing the highly variable recent human sample, accuracy increased to 84.6% for H. neanderthalensis, and 57.1% of Upper Paleolithic H. sapiens were classified correctly by using the first 4 PCs (70.3%). We conclude that caution is warranted when assigning isolated dm₁ crowns to taxa; while an assignment to H. neanderthalensis has a high probability of being correct, assignment to Upper Paleolithic H. sapiens is less certain.

Urgent manifestations of immunoglobulin G4-related disease

Objective: Immunoglobulin G₄-related disease (IgG₄-RD) is considered a chronic condition with insidious presentation, but clinical experience suggests that disease onset prompts admission to the emergency department (ED) in a sizeable proportion of patients. We assessed the prevalence of acute manifestations associated with IgG₄-RD onset requiring referral to the ED. Method: We revised our database and identified patients admitted to the ED because of symptoms latterly attributed to IgG₄-RD onset (Group 1) and those who were referred to our outpatient clinic without previous urgent manifestations (Group 2). Acute manifestations were clustered based on the anatomical region affected by IgG₄-RD. Epidemiological, clinical, and serological features of Groups 1 and 2 were compared. Results: The study included 141 patients with IgG₄-RD. Of these, 76 (54%) presented to the ED at disease onset. The most common clinical manifestations requiring admission to the ED were jaundice (53%), abdominal pain (41%), and fever (10%). Gastrointestinal involvement was the most frequent cause of referral to the ED (71% of cases), followed by involvement of the retroperitoneum (14.5%) and the nervous system (6.6%). Pancreatobiliary involvement was significantly more frequent in Group 1 than in Group 2. Head and neck, and salivary and lacrimal gland involvement was more frequent in Group 2 than in Group 1. The diagnostic delay was significantly shorter in Group 1 than in Group 2. Conclusion: Clinical manifestations associated with IgG₄-RD onset require referral to the ED in most cases. This finding contrasts with the general view of IgG₄-RD as a condition with non-acute presentation.

SAT0528 CLINICAL PHENOTYPES OF IGG4-RELATED DISEASE REFLECT DIFFERENCES IN EPIDEMIOLOGICAL FEATURES, SEROLOGICAL FINDINGS, AND PROGNOSTIC OUTCOMES

Background:

Four clinical phenotypes of IgG4-Related Disease (IgG4-RD) have been recently identified by Latent Class Analysis (LCA) - Pancreato/biliary (Group 1); Retroperitoneum/Aortitis (Group 2); Head-and-neck limited (Group 3); Mickulicz/Systemic (Group 4) - but the relevance of this classification for patient management remains unknown (1,2).

Objectives:

We aimed to assess whether clinical judgment can replicate LCA classification and to evaluate potential differences in epidemiological features, serological findings, and disease outcomes between disease phenotypes.

Methods:

The study included 179 patients. Four IgG4-RD experts were asked to classify a validation cohort of 40 patients according to published LCA derived phenotypes based on clinical judgment. Agreement between LCA and clinical clustering was calculated. To assess differences among disease phenotypes, the following variables were recorded on additional 139 patients: serum IgG4 and IgE; inflammatory markers; eosinophils; plasmablasts; IgG4-RD Responder Index (RI); history of atopy, diabetes, osteoporosis, relapses, and tumors; cumulative dose of glucocorticoids and use of rituximab.

Results:

Clinical judgment recapitulated LCA classification with strong agreement between IgG4-RD experts (κ= 0.841, p < 0.0005). Group 1 showed the highest levels of serum IgG4 and IgE. Group 2 and 4 had the lowest and highest IgG4-RD RI, respectively (Table 1). Increased cumulative doses of glucocorticoids and higher relapse rate were observed in Group 3 (Fig 1). A higher incidence of diabetes mellitus was observed in Group 1 and 4.

Table 1

Clinical and serological characteristics of patients cohort.

Group 1(59 pts - 45%)Group 2(29 pts - 22%)Group 3(25 pts - 19%)Group 4(18 pts - 14%)P valueFemale n° (%)12 (20%)8 (28%)11 (44%)5 (28%)0.18Age67 (61-73)61 (56-70)52 (40-62)57 (51-62)<0.0001Serum IgG4 (mg/dL)331 (184-575)155 (49-258)150 (80-255)282 (166-460)0.0009IgG4-RD RI9 (6-9)6 (6-9)9 (6-12)9 (6-13)0.004Definite diagnosis n° (%)20 (34%)18 (62%)20 (80%)10 (55%)0.0008Probable diagnosis n° (%)1 (0.59%)0 (0%)1 (0.19%)1 (0.14%)0.6Possible diagnosis n° (%)38 (64%)10 (34%)4 (16%)7 (39)0.0003Emergency Department n° (%)37 (63%)14 (48%)7 (28%)10 (55%)0.03History of atopy n° (%)7 (12%)4 (14%)7 (28%)6 (23%)0.09ESR (mm/h)20 (8-39)40 (14-59)38 (14-54)12 (8-21)0.04CRP (mg/L)5 (2-8)10 (3-52)8 (3-28)3 (2-6)0.03Eosinophils (cell/mm3)200 (200-500)200 (100-275)300 (200-475)200 (100-500)0.3IgE (U/mL)283 (97-723)69 (28-264)120 (41-412)219 (54-657)0.02Plasmablast (cell/mL)1765 (627-4000)1890 (1020- 4000)2000 (370- 4780)2690 (140-5130)0.99Diagnostic delay (months)4 (2-9)7 (4-12)10 (3-18)11 (2-38)0.04Starting prednisone dose(mg, range)60 (37-70)50 (40-75)65 (40-90)40 (30-70)0.8Diabetes at disease onset10 (17%)1 (3%)2 (8%)2 (11%)0.09Figure 1.

Relapse free survival of the four different IgG4-RD phenotypes.

Conclusion:

Clinical phenotypes of IgG4-RD reflect differences in epidemiological features and prognostic outcomes.

References:

[1]Bledsoe JR, Della-Torre E, Rovati L, Deshpande V. IgG4-related disease: review of the histopathologic features, differential diagnosis, and therapeutic approach. APMIS. 2018;126:459-476.

[2]Wallace ZS, Zhang Y, Perugino CA, Naden R, Choi HK, Stone JH; ACR/EULAR IgG4-RD Classification Criteria Committee. Clinical phenotypes of IgG4-related disease: an analysis of two international cross-sectional cohorts. Ann Rheum Dis. 2019;78:406-412.

Disclosure of Interests:

Marco Lanzillotta: None declared, Emanuel Della Torre: None declared, Corrado Campochiaro Speakers bureau: Novartis, Pfizer, Roche, GSK, SOBI, Gaia Mancuso: None declared, Lorenzo Dagna Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI., Consultant of: Prof Lorenzo Dagna received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI.

AB1047 IgG4-RELATED DISEASE PRESENTATION REQUIRES ADMISSION TO THE EMERGENCY DEPARTMENT IN THE MAJORITY OF CASES

Background:

IgG4-related disease (IgG4-RD) is generally considered a chronic fibro-inflammatory condition with insidious presentation and subclinical course. Our clinical experience, however, suggests that a sizable proportion of patients experience multiple accesses to the emergency department (ED), either at disease onset or during the disease course.

Objectives:

In the present study we aimed (i) to assess the prevalence of acute manifestations of IgG4-RD at disease onset requiring referral to the ED, and (ii) to calculate the diagnostic delay from the initial acute presentation.

Methods:

We revised our database and identified patients admitted to the ED because of symptoms lately attributed to IgG4-RD onset (Group 1) and those that were referred to our outpatient clinic without previous urgent manifestations (Group 2). Acute manifestations were clustered based on the anatomical district affected by IgG4-RD. Epidemiological, clinical, and serological features of Group 1 and Group 2 were compared.

Results:

The study included 141 patients with IgG4-RD. 76 (54%) presented to the ED at disease onset. The most common clinical manifestations requiring admission to the ED were jaundice (53%), abdominal pain (41%), and fever (10%). Gastrointestinal involvement was the most frequent cause of referral to the ED (71% of cases), followed by involvement of the retroperitoneum (14.5%), and of the nervous system (6.6%). Pancreato-biliary involvement was significantly more frequent in Group 1. Head, neck, salivary and lacrimal gland involvement was more frequent in Group 2. The diagnostic delay was significantly shorter in Group 1 than in Group 2.

Conclusion:

Clinical manifestations associated with IgG4-RD onset require referral to the ED in the majority of cases. This finding contrasts with the general view of IgG4-RD as a condition with non-acute presentation.

References:

[1]Bledsoe JR, Della-Torre E, Rovati L, Deshpande V. IgG4-related disease: review of the histopathologic features, differential diagnosis, and therapeutic approach. APMIS. 2018;126:459-476.

[2] Della-Torre E, Lanzillotta M, Doglioni C. Immunology of IgG4-related disease. Clin Exp Immunol.2015;181:191-206.

[3]Lanzillotta M, Campochiaro C, Trimarchi M, Arrigoni G, Gerevini S, Milani R, et al. Deconstructing IgG4-related disease involvement of midline structures: Comparison to common mimickers. Mod Rheumatol. 2017;27:638-645.

[5]Della-Torre E, Stone JH. “How I manage” IgG4-Related Disease. J Clin Immunol. 2016;36:754-763.

[6]Perugino CA, Mattoo H, Mahajan VS, Maehara T, Wallace ZS, Pillai S, et al. Emerging Treatment Models in Rheumatology: IgG4-Related Disease: Insights Into Human Immunology and Targeted Therapies. Arthritis Rheumatol. 2017;69:1722-1732.

[7]Stone JH, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med. 2012;366:539-51.

[8]Kamisawa T, Zen Y, Pillai S, Stone JH. IgG4-related disease. Lancet. 2015;385:1460-71

[9]Umehara H, Okazaki K, Masaki Y, Kawano M, Yamamoto M, Saeki T, et al. Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011. Mod Rheumatol. 2012;22:21-30.

Disclosure of Interests:

Gaia Mancuso: None declared, Emanuel Della Torre: None declared, Marco Lanzillotta: None declared, Giuseppe Alvise Ramirez: None declared, Lorenzo Dagna Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI., Consultant of: Prof Lorenzo Dagna received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI.

Labelling of Blood Platelets with Stable Tracers

Half-time values of platelets labelled with stable rubidium are compared to those of platelets labelled with Cr51. Platelets labelled with stable rubidium are assayed by a very simple version of the X-Ray fluorescence equipment. The mean quantity of rubidium incorporated by the cells is of about some µg Rb per ml blood.

The in vitro half-time of human Rb labelled platelets stored at 22° C is 41.2 ± 3h compared with the value 44.8 ± 3h for platelets labelled with Cr51, as deduced by six experiments. The in vivo half-time of rabbit platelets labelled with stable rubidium is 22 ± 3h compared with the value 18 ± 3h of platelets labelled with Cr51; ten experiments were carried out.

Oxygen Consumption in Platelets of Newborn Infants before and after Stimulation by Thrombin

The authors compared the oxygen consumption in platelets from the umbilical cord blood of 36 healthy newborn infants with that of 27 adult subjects, before and after thrombin addition (1.67 U/ml). Oxygen consumption at rest was 6 mμmol/109/min in adult control platelets and 5.26 in newborn infants. The burst in oxygen consumption after thrombin addition was 26.30 mμmol/109/min in adults and 24.90 in infants. Dinitrophenol did not inhibit the burst of O2 consumption in platelets in 8 out of 10 newborn infants, while the same concentration caused a decrease in 9 out of 10 adult subjects. Deoxyglucose inhibited the burst in O2 consumption in newborn infant and adult platelets by about 50%. KCN at the concentration of 10−4 M completely inhibited basal oxygen consumption but did not completely inhibit the burst after thrombin. At the concentration of 10−3 M, it inhibited both basal O2 consumption and the burst in infants and adult subjects.

Hyperhomocysteinemia in acute iatrogenic hypothyroidism: the relevance of thyroid autoimmunity

PURPOSE

Hyperhomocysteinemia is a known cardiovascular risk factor and a key player in the inflammatory activation of autoimmune diseases. Hashimoto's thyroiditis (HT) is the leading cause of hypothyroidism which, in itself, has been associated with a significant raise of homocysteine (Hcy) levels and increased cardiovascular risk. Our aim was to assess the impact of HT on Hcy levels in patients with acute hypothyroidism.

METHODS

We prospectively enrolled 121 patients (mean age: 46 years, F/M = 102/19) with acute post-surgical hypothyroidism. Based on the presence of anti-thyroid antibodies and the histological description of an inflammatory infiltrate, 26 and 95 patients were classified as HT and non-HT, respectively. Several parameters including thyroid-stimulating hormone (TSH), levels of serum free T3 and free T4, weight, glucose levels, total cholesterol, creatinine, vitamin B₁₂, ferritin and erythrocyte sedimentation rate were obtained from all patients and correlated with Hcy levels.

RESULTS

Median Hcy level in the whole cohort was 16.8 µmol/L (normal values: < 12 µmol/l). Among all parameters analysed, only Hcy levels were significantly different between HT and non-HT patients (median Hcy = 19.7 vs 16.2 µmol/L, respectively; p = 0.018, Mann-Whitney U test). Analysis of covariance showed the presence of HT to be the strongest predictor of Hcy levels (coefficient = 0.25534, p = 0.001). Serum TSH was not significantly associated with Hcy levels (p = 0.943).

CONCLUSION

In patients with iatrogenic hypothyroidism, those with HT have significantly higher Hcy levels than those without HT. The increase of Hcy levels appears to be mainly determined by the HT-related immune-inflammatory condition.

Measurement of intra-abdominal pressure in large incisional hernia repair to prevent abdominal compartmental syndrome

INTRODUCTION

The repair of large incisional hernias may occasionally lead to a substantial increase in intra-abdominal pressure (IAP), and rarely to abdominal compartmental syndrome (ACS) with subsequent respiratory, vascular, and visceral complications. Measurement of the IAP has recently become a common practice in monitoring critical patients, even though such measurements were obtained in the early 1900s.

PATIENTS AND METHODS

A prospective study involving 54 patients undergoing elective abdominal wall gap repair (mean length, 17.4 cm) with a tension-free technique after incisional hernia was conducted. The purpose of the study was to determine whether or not urinary pressure for indirect IAP measurement is a reliable method for the early identification of patients with a higher risk of developing ACS. IAP measurements were performed using a Foley catheter connected to a HOLTECH® medical manometer. IAP values were determined preoperatively, after anesthetic induction, upon patient awakening, upon patient arrival in the ward after surgery, and 24 h after surgery before removing the catheter. All patients were treated by the same surgical team using a prosthetic composite mesh (PARIETEX®).

RESULTS

Incisional hernia repair caused an increase in the mean IAP score of 2.68 mmHg in 47 of 54 patients (87.04%); the IAP was decreased in two patients (3.7%) and remained equal in five patients before and 24 h after surgery (9.26%). FEV-1, measured 24 h after surgery, increased in 50 patients (92.6%), remained stable in two patients (3.7%), and decreased in two patients (3.7%). The mean increase in FEV-1 was 0.0676 L (maximum increase = 0.42 L and minimum increase = 0.01 L) in any patient who developed ACS.

CONCLUSIONS

Measurement of urinary bladder pressure has been shown to be easy to perform and free of complications. Measurement of urinary bladder pressure can also be a useful tool to identify patients with a higher risk of developing ACS.

Cross-tolerance between bacterial endotoxin and group B Streptococcus in neonatal rats

Although endotoxin tolerance can be induced in newborns, potential cross-tolerance to group B Streptococcus (GBS), a common Gram-positive neonatal pathogen has not been investigated. In the present study we tested the hypothesis that endotoxin or recombinant tumor necrosis factor (rTNFα) can induce tolerance to lethal injection of heat-killed GBS in rat newborn pups and vice versa. The effect of such cross-tolerance on endogenous generation of plasma TNFα was subsequently evaluated. Rat pups (18-24 h old) were pretreated intracardially (i.c.) with either phosphate buffered saline (PBS), Salmonella enteritidis endotoxin (30 μg/kg) or rTNFα (35, 70 or 140 μg/kg). The pups were pretreated for either 4, 24, 48, 96 or 240 h prior to a lethal heat-killed GBS challenge. The susceptibility of the neonates to GBS-induced mortality was dependent on the duration of the pretreatment period. At 4 h of pretreatment with endotoxin or TNF, GBS-induced mortality was augmented relative to the PBS group. However, by 24-48 h the endotoxin and TNF pretreated neonates became more resistant to GBS-induced mortality. In a converse of the above experiment, neonates were pretreated with heat killed GBS (0.7 mg/kg) or rTNFα (70 μg/kg) and sensitivity to endotoxin was determined at 4-240 h after pretreatment. The data were qualitatively similar to endotoxin pretreatment. The 4 h GBS or TNF pretreatment rendered the neonates more susceptible to endotoxin-induced mortality. However, by 24-48 h the pretreatment groups were more resistant (P < 0.05) to endotoxin than the PBS controls. Plasma TNFα levels were increased (P < 0.05) 2 h after challenge i.c. with lethal heat-killed GBS or S. enteritidis endotoxin. In the 4 h pretreatment groups that received either GBS or endotoxin and then challenged with endotoxin or GBS, respectively, the plasma TNFα response was markedly augmented (P < 0.05). By 48 h of pretreatment, however, the plasma TNFα response in these groups to the stimuli was significantly reduced (P < 0.05) compared to the PBS pretreated groups. Therefore, plasma TNFα parallels lethality induced by GBS or endotoxin pretreatment. The ability of GBS and endotoxin to induce cross tolerance suggests that common pathophysiological pathways are involved in these syndromes.

Simultaneous occurrence of dysaesthetic peno/scroto-dynia and stomatodynia

The 'dynias' are a group of chronic focal pain syndromes with a predilection for orocervical or urogenital regions. Only exceptionally do they involve both sites in the same patient. Here, we report a case of simultaneous occurrence of dysaesthetic peno/scroto dynia and stomatodynia.

The taste of D- and L-amino acids: In vitro binding assays with cloned human bitter (TAS2Rs) and sweet (TAS1R2/TAS1R3) receptors

The taste of different enantiomeric forms of amino acids has been deeply investigated because it represents the most impressive case of correlation between stereochemistry and flavour. Herein, we aimed to elucidate the molecular activity of d- and l-amino acids using an in vitro system based on a cellular model overexpressing sweet and bitter receptors, and to analyse the correlation between in vitro and sensory studies. With our work we demonstrated specific enantiomeric activities for several amino acids on TAS1R2-TAS1R3 sweet receptor. Moreover, we proved interaction of tryptophan and phenylalanine with a specific group of TAS2Rs bitter receptors, confirming and improving the results recently obtained in the tasting of amino acids. In addition, we provide the first systematic analysis of l- and d-amino acid actions on the sweet heterodimeric receptor.

Secondary hemophagocytic lymphohistiocytosis in zoonoses. A systematic review

BACKGROUND

Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome that is often fatal despite treatment. It is caused by a dysregulation in natural killer T-cell function, resulting in activation and proliferation of histiocytes with uncontrolled hemophagocytosis and cytokines overproduction. The syndrome is characterized by fever, hepatosplenomegaly, cytopenias, liver dysfunction, and hyperferritinemia. HLH can be either primary, with a genetic aetiology, or secondary, associated with malignancies, autoimmune diseases, or infections.

AIM

To focus on secondary HLH complicating zoonotic diseases.

MATERIALS AND METHODS

PubMed search of human cases of HLH occurring during zoonotic diseases was performed combining the terms (haemophagocytic or haemophagocytosis or hemophagocytosis or hemophagocytic or erythrophagocytosis or macrophage activation syndrome) with each one of the etiological agents of zoonoses.

RESULTS

Among bacterial diseases, most papers reported cases occurring during brucellosis, rickettsial diseases and Q fever. Regarding viral diseases, most of the cases were reported in patients with avian influenza A subtype H5N1. Among the protozoan zoonoses, most of the cases were reported in patients with visceral leishmaniasis. Regarding zoonotic fungi, most of the cases were reported in AIDS patient with histoplasmosis. No cases of secondary HLH were reported in patient with zoonotic helminthes.

CONCLUSIONS

Zoonotic diseases are an important cause of HLH. Secondary HLH can delay the correct diagnosis of the zoonotic disease, and can contribute to an adverse outcome.

The role of endosomal toll-like receptors in bacterial recognition

BACKGROUND

Infections caused by extracellular Gram positive bacteria are still a major health problems. Better understanding of the mechanisms underlying immune responses to these organisms is key to develop pharmacological agents, including vaccines, to control these infections.

OBJECTIVE AND PERSPECTIVES

The objective of this review is to highlight the importance of nucleic acid-sensing, intracellular Toll-like receptors in innate immune recognition and in host defenses against extracellular bacteria.

CONCLUSIONS

Toll-like receptors 7 and 9 have a major role in inducing host-protective type I interferon responses in conventional dendritic cells in response to streptococci and other extracellular gram positive bacteria. Moreover an as yet unidentified MyD88-dependent receptor is likely responsible for proinflammatory cytokine induction in response to these pathogens.

Hepatic steatosis, carotid atherosclerosis and metabolic syndrome: the STEATO Study

PURPOSE

Hepatic steatosis is frequently observed in subjects with metabolic syndrome (MS). In type 2 diabetics, it is independently associated with cardiovascular diseases. In order to confirm and extend this finding, a large group of patients with risk factors for atherosclerosis was studied.

METHODS

Carotid atherosclerosis was investigated by echo-Doppler, and hepatic steatosis by ultrasound and transaminase values. Strict exclusion criteria were chosen in order to avoid secondary forms of fatty liver and interference on transaminase values.

RESULTS

Among 970 enrolled patients, about 20% were diabetics, half had MS and 76% presented echographic hepatic steatosis. In multivariate analyses, fatty liver and MS were associated with carotid atherosclerosis [odds ratio (95% confidence intervals) 2.15 (1.27-3.63) and 1.72(1.12-2.64), respectively], whereas HOMA index was not. Aspartate aminotransferase and alanine aminotransferase were not independently associated with carotid atherosclerosis, whereas gamma-glutamyl transferase showed a link with atherosclerosis beyond MS and steatosis presence. The analyses of the 780 non diabetics recruited showed similar results.

CONCLUSIONS

The results of the present study demonstrate that hepatic steatosis measured by echography is associated with carotid atherosclerosis in a large population mostly carrying cardiovascular or metabolic risk factors, independently of MS, cardiovascular diseases, diabetes mellitus and/or insulin resistance.

Procalcitonin as a marker of nosocomial infections in the neonatal intensive care unit

OBJECTIVE

To determine accuracy of procalcitonin concentrations for diagnosing nosocomial infections in critically ill neonates.

DESIGN

Case-control study.

SETTING

Neonatal intensive care unit of a teaching hospital.

PATIENTS

Twenty-three neonates with nosocomial infection. Four controls matched for duration of hospital stay and birth date were chosen for each case patient.

MEASUREMENTS AND RESULTS

PCT concentrations were measured by the LUMItest procalcitonin kit at onset of signs of infection and after recovery. Range of PCT concentrations (ng/ml) was 2.0 to 249.1 in case patients and 0.08 to 1.0 in controls (sensitivity and specificity, 100%). PCT values returned to normal (<1.0 ng/ml) by day 3 to 7 of appropriate antibiotic therapy.

CONCLUSIONS

Measurement of PCT concentrations may be useful for early diagnosis and monitoring of infectious complications in neonates during their stay in the neonatal intensive care unit.

Relationships between platelet counts, platelet volumes and reticulated platelets in patients with ITP: evidence for significant platelet count inaccuracies with conventional instrument methods

The platelet count has a primary role in the diagnosis and treatment of idiopathic thrombocytopenic purpura (ITP). This study analysed the accuracy of ITP patient platelet counts determined by Abbott CD-Sapphire (impedance/optical) and Bayer Advia 120 (optical) analyses, compared with a reference immunoplatelet method. Instrument platelet estimates showed broad equivalence in the higher range of observed values, but significant discrepancies against the immunoplatelet count were seen when platelet counts were <10 x 10(9)/l. CD-Sapphire mean platelet volume (MPV) results revealed increased (>12 fl) platelet volumes in eight of eight ITP patients with counts of <20 x 10(9)/l compared with 6/6 and 5/13 patients with platelet counts of 20-50 and >50 x 10(9)/l. In contrast, Bayer Advia MPV values showed no relationship with the platelet count. Increased reticulated platelets were associated with an increasing CD-Sapphire MPV (R(2) = 0.61) and a decreasing platelet count. High (>40%) reticulated platelet values were seen in 9/9 patients with immunoplatelet counts of <20 x 10(9)/l compared with 0/19 patients with platelet counts above 20 x 10(9)/l. There may be a need for caution in the interpretation of platelet counts in ITP patients obtained with conventional instrument methods, and therapeutic decisions should ideally be validated by reference immunoplatelet procedures.

Diagnosis of congenital toxoplasmosis: pre- and post-natal evaluation in Sicilian (Italy) epidemiological area. Preliminary data

To evaluate the usefulness of conventional serological methods with western blot assay (WB) in congenital toxoplasmosis diagnosis, we prospectively enrolled in a clinical and serological follow-up all pregnant women with Toxoplasma gondii infection and their offspring, referred to us from October 2004. Western blot and standard serological test were performed on sera collected from mother during pregnancy and from mother and child at birth, at postpartum month 1-3-6-9 and 12. At this point in time, 22 pregnant women and 14 infants have completed the follow-up. 4 newborns were infected and 2 had specific toxoplasmosis anomalies at the birth. In mothers without seroconversion, the WB performed during pregnancy demonstrates the highest accordance with postnatal follow-up whereas in 1 case the negative result of PCR analysis was not confirmed by postnatal observation. The detection of anti-T gondii IgG against 8 kDa accessory antigenic band and against the accessory band included between 35 and 40 kDa band in immunoblot assay was useful for diagnosis of acute phase but did not improve the evaluation of comparative postnatal profile. Althougth few infants have concluded the postnatal follow-up, the preliminary results showed a greater value of using a IgM and IgA WB test than other standard method for the early diagnosis of toxoplasmosis at birth also in child born to treated mothers. The comparative anti-T gondii IgG immunoblot profile of mother and child permitted us to reduce the time of ruling out infection in newborns born to mothers with probable or possible infection and/or when prenatal diagnosis is negative or not performed.

Toxoplasma gondii infections in sheep in Sicily, southern Italy

The aim of the study was to determine the burden of Toxoplasma gondii-infections in sheep in Sicily, southern Italy and the risk factors for infection. Sera from 1961 sheep were collected just before slaughtering from 62 farms located in 8 out of 9 Sicilian administrative districts. The sera were analysed for Toxoplasma-specific IgG antibodies using commercially available enzyme-linked immunosorbent assay. Sheep less than 4 weeks old were further analysed by ELISA for Toxoplasma-specific IgM-antibodies. Data on farm size and location were obtained from slaughterhouse sanitary reports and through structured telephone interviews of the veterinary officers from public health districts. The overall seroprevalence of Toxoplasma-specific IgG-antibodies were 49.9% (937/1876) by ELISA. Eighty-seven (54/62) percent of the farms had at least one Toxoplasma-positive animal. All the farms fed the animals outdoor on pasture and only one was claiming organic farming. Having cats on the farm, age of the animals, farm size and the use of surface water sources for drinking were all significantly associated with T. gondii-infected animals on the farm. T. gondii infection in mutton used for human consumption is very prevalent, and eating unprocessed sheep and lamb meat has a high risk of transmitting infections to humans. The presence of cats on the farm, farm size and using surface water as drinking water for the animals were risk factors for infection in sheep, with age as a significant confounder.

A prospective randomized trial of high and standard dosages of recombinant factor VIIa for treatment of hemarthroses in hemophiliacs with inhibitors

AIM

A multicenter randomized open-label crossover prospective trial was designed to compare the efficacy, safety, and cost of standard and high dosages of recombinant factor VIIa (rFVIIa) for home treatment of hemarthroses in hemophiliacs with inhibitors.

METHODS

Patients were instructed to treat, within 6 h from the onset of bleeding, four consecutive hemarthroses of ankles, knees, or elbows, either with the rFVIIa standard dose of 90 microg kg(-1) (repeated as necessary every 3 h) or with a single high dose of 270 microg kg(-1). Patients who did not achieve a clinical success within 9 h continued rFVIIa treatment with repeated standard doses. Response to treatment was assessed for up to 48 h by patients/caregivers, who reported on a Visual Analogue Scale (VAS) graded from 0 to 100 the improvement in symptoms and also rated the responses as effective, partially effective or ineffective. Success was defined a treatment course rated as effective and with a VAS score > or =70 and failure a treatment course rated as ineffective and VAS score < or =30, whereas treatment courses that did not fulfill these criteria were considered partial responses.

RESULTS

Twenty hemophiliacs with inhibitors were originally enrolled (median age: 27 years), 18 of them treated 32 hemarthroses assigned to the standard-dosage and 36 to the high-dosage regimen, during the study period of 18 months. Forty-eight hemarthroses (71%) occurred in target joints. Success rates for standard- and high-dosage regimens were similar: 31% and 25% at 9 h, 53% and 50% at 24 h, 66% and 64% at 48 h, the end point for outcome assessment. The median number of rFVIIa infusions needed to achieve a successful course was significantly greater for the standard-dosage (n = 3) than for the high-dosage regimen (n = 1), and the median amount of rFVIIa ultimately used per successful course was identical (270 microg kg(-1)).

CONCLUSION

Our results indicate that a high-dosage regimen with rFVIIa for home treatment of hemarthroses is effective, safe, does not imply an increased consumption of rFVIIa and requires the infusion of a smaller number of rFVIIa doses. Its convenience is particularly relevant in cases with difficult venous access and in hemorrhages into target joints.