Lactobacillus rhamnosus GG supplementation on eradication rate and dyspepsia in Helicobacter pylori infection treated with three-in-one bismuth quadruple therapy

Introduction

Helicobacter pylori (Hp)-related dyspepsia has been related to gastroduodenal dysbiosis. The role of probiotic supplementation in the clinical management of Hp infection has been the object of several studies in terms of improvement of efficacy and tolerability of eradication treatments but data on their effects on the outcomes of post-eradication dyspepsia are lacking. The aim of the present study was to evaluate the influence of Lactobacillus rhamnosus GG (LGG) supplementation on bismuth quadruple therapy (BQT) in the clinical management of Hp-related infection both in terms of efficacy and tolerability and persistence of post-treatment dyspepsia.

Methods

A total of 164 (121 women) Hp-positive adult patients were enrolled in this pilot study and assigned to two different treatment regimens: group A received BQT for 10 days (three capsules qid, IPP bid) and group B received BQT for 10 days in combination with 6 × 10⁹CFU LGG (ATCC53103) taken for 24 days (7 days before, 10 days during, and 7 days after therapy). Eradication was assessed after 45 days using the ¹³C-urea breath test (¹³C-UBT). Dyspepsia, distinguished into postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS), was assessed at the time of enrollment and 6 months after eradication.

Results

Approximately 98 patients were enrolled in group A and 66 patients in group B. At the enrollment, dyspepsia was present in 76.5% of group A and 86.5% of group B. No significant differences were observed in eradication rate between the 2 groups, both in intention-to-treat (ITT) analysis (82.3 vs. 75.0%) and per-protocol (PP) analysis (95 vs. 96%), and in the presence of side effects during the treatment (70.6 vs. 65.4%). At 6 months after eradication of Hp infection, the persistence of dyspepsia was statistically higher in patients of group A than in group B (38.8 vs. 16.1%; p = 0.032). The positive influence of LGG supplementation in improving post-eradication dyspepsia resulted in statistically more effectiveness in PDS dyspepsia, whose remission was 41.7% in group A and 84% in group B patients (p = 0.011).

Conclusion

In conclusion, LGG supplementation during Hp eradication therapy, even if not affecting eradication rates and therapy-related side effects, significantly impacts the remission of dyspepsia.

The Potential Role of Hypochlorhydria in the Development of Duodenal Dysbiosis: A Preliminary Report

In recent years, the role of gastric and duodenal microbiota has acquired increasing importance in the homeostasis of the host, although, to date, most evidence concern the faecal microbiota. Indeed, the gastric, and duodenal microbiota are challenging to study, due to gastric acid, bile, digestive enzymes, and rapid transit time. Specifically, the gastric acid environment may influence their bacterial composition since the acid barrier protects against orally ingested microorganisms and leads to their inactivation before reaching the intestine. The aim of this study was to assess a correlation between intragastric pH and gastric as well as intestinal microbiota of patients with histologic gastric alterations. pH was measured in the gastric juice and the bacterial composition in gastric and duodenal biopsies and faecal samples, was investigated via 16s rRNA gene sequencing. The main result is the direct correlation of duodenal microbiota biodiversity, via alpha diversity measures, with intragastric pH values. In particular, patients with hypochlorhydria showed increased duodenal microbiota biodiversity, higher intragastric pH values being prevalent in patients with chronic atrophic gastritis. Lastly, the latter was also strongly associated to the presence of oral bacteria, like Rothia mucilaginosa, Streptococcus salivarius and Granulicatella adiacens, in the duodenal microbiota. In conclusions, our results suggest a low-acid gastric environment as a contributive factor for duodenal dysbiosis, potentially leading to the development of pathological conditions of the gastrointestinal tract.

"Metabolic and cardiovascular response to exercise in patients with type 1 diabetes"

PURPOSE

Physical activity is an effective therapeutic tool for cardiovascular risk prevention. However, exercise aerobic capacity of patients with type 1 diabetes (T1DM) has not been thoroughly investigated. Aim of the present study is to evaluate exercise aerobic capacity in patients with T1DM compared to a normal control population.

METHODS

This observational study included 17 T1DM patients and 17 matched healthy volunteers. Cardiopulmonary exercise test (CPET) was conducted on an electronically-braked cycle ergometer. Blood samples were collected for evaluation of glycemia and lactate levels.

RESULTS

Mean oxygen uptake at peak exercise (V'O_2,peak) was significantly lower in T1DM subjects (V'O_2,peak T1DM 2200 ± 132ml/min vs V'O_2,peak Healthy subjects of 2659 ± 120 ml/min p = 0.035). Cardiovascular response analysis did not show statistically significant differences. Respiratory exchange ratio (RER) was significantly higher in healthy subjects at peak exercise and at the first minute of recovery (p = 0.022, p = 0.024). Peak exercise lactate levels were significantly higher in healthy subjects. There was no statistical correlation between CPET results and diabetes-related parameters.

CONCLUSIONS

Patients affected by T1DM have a worse exercise tolerance than normal subjects. The two groups differed by RER which can be greatly influenced by the substrate type utilized to produce energy. Because of the impaired carbohydrate utilization, T1DM subjects may use a larger amount of lipid substrates, such hypothesis could be strengthened by the lower lactate levels found in T1DM group at peak exercise. The lack of correlation between exercise tolerance and disease-related variables suggests that the alterations found could be independent from the glycemic levels.

Cytokine Levels in Serum and Cerebrospinal Fluid during Tetanus: Possible Immune Activation

Because of the possible involvement of cytokines in tetanus, we investigated the cerebrospinal fluid (CSF) and serum levels of granulocyte-macrophage-CSF (GM-CSF), tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-1 alpha (IL-1 alpha), and interferon-gamma (IFN-gamma) in eight patients affected by uncomplicated tetanus before intrathecal therapy with immunoglobulins. We observed a significant increase of cytokines levels in CSF respect to controls (p<0.001). In particular IFN-gamma, followed by GM-CSF, IL-6 and TNF-alpha, while IL-1 alpha was not detectable in either serum or CSF. Moreover, no correlation was found between serum and CSF cytokine levels. These results could indicate an intrathecal production of these cytokines and a possible immunologic activation occuring in the central nervous system (CNS). Since this study is preliminary, we do not conclude that the measurement of cerebrospinal fluid cytokine levels could represent a useful marker in the course of tetanus.

Effect of acetazolamide on post-NIV metabolic alkalosis in acute exacerbated COPD patients

OBJECTIVE

Non-invasive ventilation (NIV) is an effective treatment in patients with acute exacerbation of COPD (AECOPD). However, it may induce post-hypercapnic metabolic alkalosis (MA). This study aims to evaluate the effect of acetazolamide (ACET) in AECOPD patients treated with NIV.

PATIENTS AND METHODS

Eleven AECOPD patients, with hypercapnic respiratory failure and MA following NIV, were treated with ACET 500 mg for two consecutive days and compared to a matched control group. Patients and controls were non invasively ventilated in a bilevel positive airway pressure (BiPAP) mode to a standard maximal pressure target of 15-20 cmH2O.

RESULTS

ACET intra-group analysis showed a significant improvement for PaCO2 (63.9 ± 9.8 vs. 54.9 ± 8.3 mmHg), HCO3- (43.5 ± 5.9 vs. 36.1 ± 5.4 mmol/L) and both arterial pH (7.46 ± 0.06 vs. 7.41 ± 0.06) and urinary pH (6.94 ± 0.77 vs 5.80 ± 0.82), already at day 1. No significant changes in endpoints considered were observed in the control group at any time-point. Inter-group analysis showed significant differences between changes in PaCO2 and HCO3- (delta), both at day 1 and 2. Furthermore, the length of NIV treatment was significantly reduced in the ACET group compared to controls (6 ± 8 vs. 19 ± 19 days). No adverse events were recorded in the ACET and control groups.

CONCLUSIONS

ACET appears to be effective and safe in AECOPD patients with post-NIV MA.

Prevalence of Genotypic Resistance to Nucleoside Analogues and Protease Inhibitors in Antiretroviral-Naive HIV Patients in Campania, Italy

The aim of our study was to determine the prevalence of genotypic resistance to nucleoside analogues and protease inhibitors before and after 1997, the year of introduction of Highly Active Antiretroviral Therapy (HAART) in Campania (Italy). Forty-eight plasma HIV-RNA positive patients who had not been previously treated for HIV infection (naïve) were enrolled in two Divisions of Infectious Diseases. The main demographic characteristics were collected for each subject and the primary mutant genotypes were sought only in HIV-RNA positive patients with viral loads higher than 10,000 copies/ml. The diagnosis of HIV infection dated back to before 1996 for 21 out of 48 patients and to after 2000 for the other 27. INNO-Line Probe Assay (LiPA) HIV-RT and INNO-LiPA HIV protease (Innogenetics, Italy) were used to detect mutations conferring resistance to zidovudine, didanosine, zalcitabine, lamivudine, stavudine, saquinavir, indinavir, rotonavir, nelfinavir and amprenavir. No mutations associated with primary resistance to nucleoside analogues and protease inhibitors were detected in the 21 patients who had acquired HIV infection before 1996, whereas one or more mutations were seen in three of the 27 (11.1%) patients with HIV infection diagnosed after 2000. This study confirms that LiPA is a suitable tool for epidemiological surveys of HIV genotypic primary resistance. Drug-resistant HIV-1 genotypes, resistant both to nucleoside analogues and protease inhibitors, were detected only in subjects who had acquired HIV infection after 2000, most of whom had zidovudine-resistant mutants. These data suggest that the introduction of HAART has brought about the circulation of drug-resistant HIV genotypes.

Hip fractures in Italy: 2000-2005 extension study

SUMMARY

A total of 507,671 people > or =65 experienced hip fractures between 2000 and 2005. In 2005, 94,471 people > or =65 were hospitalized due to hip fractures, corresponding to a 28.5% increase over 6 years. Most fractures occurred in patients > or =75 (82.9%; n = 420,890; +16% across 6 years), particularly in women (78.2%; n = 396,967).

INTRODUCTION

We aimed to analyze incidence and costs of hip fractures in Italy over the last 6 years.

METHODS

We analyzed the national hospitalization and DRG databases concerning fractures occurred in people > or =65 between 2000 and 2005.

RESULTS

A total of 507,671 people > or =65 experienced hip fractures across 6 years, resulting in about 120,000 deaths. In year 2005 94,471 people aged > or =65 were hospitalized due to hip fractures, corresponding to a 28.5% increase over 6 years. The majority of hip fractures occurred in patients > or =75 (82.9%; n = 420,890; +16% across 6 years) and particularly in women (78.2%; n = 396,967). Among women, 84.2% of fractures (n = 334,223; +28.0% over 6 years) were experienced by patients > or =75, which is known to be the age group with the highest prevalence of osteoporosis, accounting for 68.6% of the overall observed increase in the total number of fractures. Hip fractures in men > or =75 increased by 33.1% (up to 16,540). Hospitalization costs increased across the six examined years (+36.1%) reaching 467 million euros in 2005, while rehabilitation costs rose up to 531 million in the same year.

CONCLUSIONS

Hip fractures of the elderly are increasing and represent a major health problem in industrialized countries such as Italy.

[Biological risk in the operating room: microbiological monitoring of the environment and analysis of the associated variables]

The authors present an environmental microbiological monitoring programme carried out over a period of 15 months in 16 operating theatres performing specific types of surgery. The levels of microbial contamination of the air and of four of the most representative surfaces of the clean area were determined at 3 different times for each theatre, both before and during surgery. For the air assessment, the results obtained with three different samplers, Sed-3 Unit, SAS and RCS, were compared. The results were on the whole acceptable, but some poor conditions were detected during the theatres in use, especially in general surgery theatres; in some of these the floors showed levels of contamination consistently exceeding the reference limits. As the monitoring programme proceeded, the microbiological quality of the air and of the surfaces in the theatres notably improved. The three air samplers showed different conditions expressed with units of measure not always readily comparable. For active samplers, the bacterial load determined by RCS, although less variable, were always higher (even 2-3 fold) than those obtained with the SAS. Passive sampling takes longer but determines the real risk of infection for the patients; contemporary determination of the fall-out and the CFU/m3 helps to identify the occupational risks. Since the limit values established by the ISPESL guidelines for the operating theatres have been defined only for active samplers, there is urgent need for more exhaustive national guidelines to define similar values also for passive sampling. The Authors conclude stressing the importance of promoting continuing information-education programmes to heighten the awareness of all those involved in operating theatre activities.

Candida spp. morphotype differentiation on Sabouraud-Triphenyltetrazolium-Agar (STTZ-Agar) under three different experimental conditions

One hundred and thirty-two strains of Candida spp. were cultured on STTZ-Agar at 37 degrees C for 6 days and at 25 degrees C for 6 and 21 days to determine the culture conditions that would ensure maximum reproducibility in the discrimination of the strains of the same species. Standardization is of utmost importance, as varying experimental conditions can alter the results of the tests. Further studies are needed also implementing molecular tests to establish possible relationships between morphotype, genotype and virulence.

[Microbial environmental monitoring in the dental surgery room]

The aim of our study is to analyse the contamination level of air, water and hard surfaces before and after works activities in a dental clinic. Four different methods are detected for the sampling of the hard surfaces: contact plates, nitrocellulose membranes, swab and mask system, bioluminometer. Our results are overall satisfactory, but few critical situations related to some practice, were observed. In comparing the four methods of sampling the hard surfaces, the use of bioluminometer although referring to indirect indices, appears to give results comparable to those obtained with the contact plates and nitrocellulose membranes, which determine the microbiologic count. Contact plates and nitrocellulose membranes appear to be of more friendly use and show same results.

Retrospective analysis of the association of nodular goiter with primary and secondary hyperparathyroidism

BACKGROUND

The association of hyperparathyroidism (HPT) with thyroid disease has long been known, but the mechanisms underlying such an association have not yet been clarified.

OBJECTIVE

To elucidate the main factors determining this combination of endocrine diseases, in a retrospective multicenter study.

METHODS

We retrospectively reviewed all patients referred for parathyroid scintigraphy in the period 1990-1999. A total of 487 patients in the age range 17-65 years were selected for the analysis (339 women and 148 men); group A included 241 patients with primary and group B 246 patients with secondary HPT.

RESULTS

A total of 124/241 patients in group A (51.5%), but only 92/246 patients in group B (38.2%) had thyroid disorders (notably nodular goiter) associated with HPT (P=0.0035). Thyroid disorders were evenly distributed throughout the entire 17-65 years age range in group A, but 17-40-year-old patients in group B had significantly fewer thyroid disorders than the older patients of the same group (15.5% compared with 43.3%, P<0.002), as expected in a general population. In patients with primary HPT there was no difference in the prevalence of thyroid disease between women and men, whereas the ratio of women to men in secondary HPT patients with thyroid disease was about 3:1.

CONCLUSIONS

These results demonstrate an increased prevalence of nodular goiter in patients with primary rather than secondary HPT, and are consistent with a possible role of increased endogenous calcium concentrations (a hallmark of primary, but not of secondary, HPT) as a goitrogenic factor in patients with HPT.

Ill-defined and multiple causes on death certificates--a study of misclassification in mortality statistics

Biases can distort, limit or inhibit the value of mortality data as an epidemiological re source. From 9500 deaths occurring in Naples (Italy during 1994, a random sample of 372 death certificates reporting ill-defined causes and multiple causes of death was extracted. The code for the underlying cause on the death certificate (assigned code) was compared with the cause reattributed with the aid of interview of the certifying physician or clinical records (modified code). The aim was to investigate the extent of misclassification of 'underlying cause' in deaths attributed to ill-defined and/or multiple causes and the shortcomings in the ICD-IX. Ill-defined underlying causes of death (7.0% of death certificates) were cardiovascular diseases, tumours with no specified site or nature, symptoms, signs, ill-defined conditions and senility. There was disagreement between the initially assigned code and the modified code in 53.8% of ill-defined underlying causes; discordance was high for the certificates filled in by the family physician. Multiple causes of death were observed in 23.6% of certificates; of these 59.2% concerned subjects aged 75 years and over at death. Diabetes was always listed in association with other pathologies but neoplasms and traumas were generally listed alone. Disagreement between codes occurred in 48 (54.5%) certificates indicating multiple causes. In 10 of them, death was established as due to a concurrence of causes. As regards ill-defined causes of death, the authors concluded that specific training on certifying procedures would be insufficient on their own; the physician should be made aware that certification is a fundamental requirement for building up epidemiological data. Evidence-based educational interventions are needed. As regards multiple causes of death, multicausal analysis may be indicated for deaths due to a concurrence of causes.

Somatostatin-induced modulation of inflammation in experimental arthritis

OBJECTIVE

To study the antiinflammatory effect of different doses of intraarticular somatostatin in experimental arthritis in rabbits.

METHODS

Chronic arthritis was induced by a single injection of fibrin into the knee joint of rabbits previously sensitized to this antigen. The effects of sequential intraarticular injections of somatostatin into the rabbit knee, at doses of 500, 750, and 1,000 micrograms, were monitored by measuring knee joint circumferences and hematologic parameters. The measurements were compared with those obtained following use of triamcinolone acetonide and placebo. At the end of the experiments, the knee joints were examined histologically.

RESULTS

Somatostatin treatment induced a statistically significant and dose-related reduction of knee joint swelling. This effect was shorter than that produced by triamcinolone acetonide; however, the antiinflammatory activity elicited by successive doses of triamcinolone acetonide declined both in extent and duration, while the effects of somatostatin remained unchanged at each successive treatment. Histopathologic observations showed that both somatostatin and triamcinolone acetonide reduced the inflammatory signs in the joint structures, although triamcinolone acetonide appeared to be more effective.

CONCLUSION

These findings suggest that somatostatin exerts an antiinflammatory effect in this model of experimental arthritis and may represent a valid and safer alternative to corticosteroids for intraarticular therapy of arthritis.

Properties of Yersinia enterocolitica porins: interference with biological functions of phagocytes, nitric oxide production and selective cytokine release

We have extracted and purified Yersinia enterocolitica ATCC 9610 porins that have molecular weights of 36-38 kDa. They inhibited phagocytosis and phagosome-lysosome fusion (30%) in human monocytes and caused enhanced nitrite production. Preincubation of polymorphonuclear neutrophils with porins (1-10 micrograms/ml/10(6) cells) induced a reduction in chemotaxis, adherence to nylon wool and chemiluminescence. Human lymphomonocytes treated with Y. enterocolitica porins showed a distinctive cytokine profile. Interleukin-1 alpha, interleukin-6 and tumour necrosis factor alpha were released within 3-6 h, while interleukin-8, gamma interferon and granulocyte-macrophage colony stimulating factor were released after 18 h. Interleukin-3 and interleukin-4 were not detected at up to 48 h of incubation. In conclusion, these immunomodulating and histotropic properties may account for Y. enterocolitica infection and its sequelae.

Immunobiological activities of Helicobacter pylori porins

Studies were carried out on some biological activities of Helicobacter pylori porins in vitro. We extracted and purified a porin with an apparent molecular mass of 30 kDa. Human polymorphonuclear leukocytes preincubated with H. pylori porins showed a decrease of chemotaxis, of adherence to nylon wool, and of chemiluminescence. Used as chemotaxins in place of zymosan-activated serum or as chemotaxinogens in place of zymosan, the porins induced polymorphonuclear leukocyte migration. Human monocytes and lymphocytes cultivated in the presence of H. pylori porins released cytokines. Release of the various cytokines studied was obtained with differentiated kinetics and at various porin concentrations. Starting only 3 h after culture, tumor necrosis factor alpha is released quickly, reaching a peak at 18 h, at a porin concentration of 1 microgram/ml/10(6) cells. Interleukin-6 (IL-6) appears later, with a peak at 10 micrograms/ml/10(6) cells, while IL-8 is released after 6 h of culture, with a peak at 24 h, at a porin concentration of 10 micrograms/ml/10(6) cells, while IL-8 is released after 6 h of culture, with a peak at 24 h, at a porin concentration of 10 micrograms/ml/10(6) cells. Lymphocytes stimulated by H. pylori porins release gamma interferon after 18 h of culture at higher concentrations of porins (20 micrograms/ml/10(6) cells). Granulocyte macrophage colony-stimulating factor is released from 6 to 48 h at a concentration of 1 microgram/ml/10(6) cells, while both IL-3 and IL-4 are released after 18 h of culture at different porin concentrations (0.1 and 1 microgram/ml/10(6) cells, respectively). Our results lead us to think that during H. pylori infection, surface components, porins in particular, are able to induce a series of chain reactions ranging from the inflammatory to the immunological responses.

An archipelago of CpG islands in Xq28: identification and fine mapping of 20 new CpG islands of the human X chromosome

19 probes for CpG islands, mapping to Xq28, have been used as probes to construct a physical map of genes of this band of the human X chromosome. A total of 22 CpG islands have been precisely mapped in respect to known loci along the 9-10 Mb of Xq28. The fine mapping of such a large number of CpG islands has demonstrated that also in gene rich Giemsa light bands, like Xq28, gene distribution is non uniform: the CpG islands are clustered in the distal portion of the band in a 2 Mb region between the G6PD gene and the DXS15 locus. Moreover, 16 CpG islands were found between the G6PD and the RCP/GCP genes, a region of DNA of only about 300 kb. If this structural organization has a biological function it has yet to be determined. However, the isolation of large genomic regions enriched in gene sequences and the availability of cosmid or YAC contigs will provide the means to test the significance of such gene organization, as well as the material for large sequencing projects and gene search, for the identification of candidate genes for inherited disorders mapped to Xq28 and for comparative mapping.

[A current problem: the prevention of malaria]

The A.A. weight present criteria of choice in order to set right a correct and effective anti-malarial prophylaxis. In the last ten years, a progressive increase of tropical diseases has been observed. This is due to the considerable growth of intercontinental traffic and of the number of persons moving to or from tropical areas where such diseases are endemic. Among these, malaria represent the most alarming problem, both because of the incidence cases and the difficulties related to the efficacy of pharmacological remedies for the chemoprophylaxis. In particular, three are now various pharmacological possibilities for malarial prophylaxis. Undoubtedly Chloroquine is the most efficacious even if there are many Plasmodium falciparum species resistant to Chloroquine and to other available medicines (multi-resistance). Most authors recommend to associate Chloroquine to others pharmacological substances to avoid pharmaco-resistance phenomena. Among the most famous pharmacological products used elsewhere are Fansidar, Maloprim, Paludrine and Lapudrine, not all are available in Italy. In China, for the therapy of resistant forms of malaria, the Qinghaosu a "schizont-killer" acting on multiresistant plasmodium falciparum has been utilizing for years. The Qinghaosu is not responsible for the crossing-reactions with other anti-malarial medicines. Various substances with Ca-antagonist action (Verapamil) are being experimented. It is supposed that Verapamil associated with Chloroquine can stop the flow of chlorine from plasmodium cells. The same mechanism is expected to be valid also for Desipramine, an experimental tricyclic anti-depressive when associated to Chloroquine. To the people moving to endemic areas, the A.A., at the end, suggest a series of practical norms to prevent infection and, therefore, the incidence of imported cases, still increasing at the moment, due to the absence of efficacious vaccine.

Pharmacokinetics of intravenous immunoglobulin in neonates

Intravenous immunoglobulin (IVIG) may be a therapeutic adjunct to antibiotic treatment of neonatal infections. We examined the pharmacokinetics and safety of IVIG in human neonates. Thirty neonates with suspected sepsis were randomly assigned either to a treatment (receiving either 250, 500, or 1,000 mg/kg of IVIG plus antibiotics) or control (antibiotics alone) group. The 500 mg/kg dose produced a rise in total IgG for greater than 8 and in group B streptococcus (GBS) type-specific IgG for greater than 4-14 days. The type-specific antibody elevation varied with the amount of pathogen-specific antibody and dose of IVIG. Pharmacokinetic analysis suggests a Vdss of 42 ml/kg, Cl of 3.0 ml/kg/day, a biphasic elimination curve, and a terminal elimination half-life of 24.2 days. No toxicity was observed. These data may be valuable in determining optimal dosing schedules for IVIG in treating or preventing neonatal infections.

Evaluation of the oral toxicity of spinacine hydrochloride in a 13-week study in rats

Spinacine (4,5,6,7-tetrahydro-1H-imidazo[4,5-c]pyridine-6-carboxylic acid), the major reaction product of formaldehyde added to Grana Padano cheese, was administered to five groups of ten rats of each set at dietary concentrations that provided doses of O (control), 15, 30, 60 or 300 mg/kg body weight/day for 13 wk. There were no adverse effects upon survival, growth or food intake. No significant treatment-associated changes were found in haematological parameters, in serum chemistry or organ weights at the end of the study. At autopsy, neither gross nor histological modifications were attributable to treatment with spinacine. In this study the no-effect dose level for spinacine was considered to be 300 mg/kg body weight/day.

[Intestinal parasitosis in canteen employees: a quadrennial study]

Giardia Lamblia is the flagellated protozoan of intestinal-tract more frequently diagnosed. This disease is well known all over the world, particularly in hot countries and under precarious hygienic-environmental conditions. In Italy the rate of infestation is around 8%. The giardiasis affects people of every age. The disease can be transmitted either by direct contagion or through the ingestion of food contaminated by cysts. Some A.A. believe that in the last years real epidemics in adults occurred, due to the current changing in the habits of life, in particular as regards food and the use of canteens. The italian law demands the competent sanitary authorities to prepare diagnostical procedures for sanitary checks, to be carried out for consignment and renewal of the employment card and for periodical checks on production, manipulation, transport and sale-staff. In a quadrenniale study (1985-1988) the A.A. estimate the incidence of the intestinal parasites and they evaluate the real danger and risks deriving from the contamination of food, by checking 160 canteen-men working in a know metal-mechanical industry in our country, through periodical parasitological stool examination. The parasitological stool exam was carried out bright and after enrichment by Ritchie's method. The Giardia Lamblia, that certainly is the ++intestinal parasite more often isolated in our country, has been observed with varying frequency during the examined period from 1.9% to 5.6%. In 4 years, 38% of these patients, even undergoing specific therapy, has shown relapsing and recurrent infestations both in the following year and later.(ABSTRACT TRUNCATED AT 250 WORDS)

[Recent experience with mites in stored products]

The A.A. refer a recent experience about the isolation and identification of same species of storaged timber mites. They believe that these mites are responsible of dermatitis at the trunk and the arms of timber workers. Mites are the most elderly living species on the earth, they can live and grow in different environments, such as plants, flowers, animals, men, earth, lake and sea waters, organical rubles, houses, mattresses, old books etc. There are free-living, saprophitic, parasitic and predator mites. Generally, primary mites live either freely or as commensals feeding on conserved foodstuff and on what they find available. Secondary mites, i.e. parasites and predators, live off primary mites and insects infesting foodstuff. Direct damage to foodstuff are not to be considered important, whereas indirect damages are more serious, due to the contamination of bodies and stools of mites that are rich in nitrogen. Some secondary mites may attack foodstuff workers causing characteristic dermatitis: they can act either directly, by sting and bites, or indirectly, provoking on allergic hypersensitivity. In this study the A.A. used the floating method to isolate timber mites, and then, these have been photographed at the microscope to obtain an easier and more complete identification. The A.A. describe a heterogeneous fauna consisting of both adult and larval-status insects, some species of free-living mites (Oribatula Tibialis) and, in particular, of two species secondary mites, predator, belonging to the Prostigmata sub-order. The Cheyletus Eruditus (Cheylatidae family) is a whitish mite feeding mostly on insect larva and primary mites living in foodstuff. When no prey is available, the Cheyletus Eruditus eats individuals of its own species. The Pyemotes Herfsi (Pyemotidae family) is a little white mite feeding on insect larva. It lives in conserved foodstuff and may attack man causing characteristic dermatitis such as those described by the A.A. The A.A. conclude dealing with the possible preventive and therapeutic measures tend to keep phisic-chemicals parameters of foodstuff and others conserved products afar from the values suitable for the growth of parasites (water content min. 13%, environmental humidity min. 60-65%, appropriate temperature etc.). Therapeutic procedure are based either on physical media: infra-red rays, gamma-rays, electric fields for the transformation of temperature or using chemical mixtures containing methyl bromide, carbon tetrachloride and hydrogen sulphide. Among the therapeutic procedures, however, the biological pest control using chemical media associated with antagonist mites of the infesting species is to be preferred.

[Prevention of AIDS in the dental area]

After a brief analysis of the present epidemiological situation both international and of our country, on the possibility of early diagnosis on clinical and laboratory bases, the A.A. dwell upon the most frequent dental pathologies in case of AIDS and upon the possibilities of singling patients suffering from the so-called "spy-lesions" of the oral cavity, which are characteristic in most cases. The A.A. conclude by reporting the methodologies (materials and methods) which are to be used, from time to time, in order to carry out a careful and correct anti-AIDS prophylaxis in dentistry, either of individuals and medical personnel or of instruments and work-environments.

Perinatal factors associated with early-onset intracranial hemorrhage in premature infants. A prospective study

Serial ultrasound examinations were performed on 40 consecutive newborn infants less than 35 weeks' gestational age. Fifteen of 17 infants with intracranial hemorrhage (ICH) had evidence of hemorrhage on the first ultrasound examination (mean age, 1.9 +/- 0.2 hours post partum). Comparing the clinical course of these 15 infants with age- and weight-matched non-hemorrhage controls showed a significant association between the occurrence of early ICH and the pattern of labor. There was no correlation between ICH and the mode of delivery, the use of sodium bicarbonate, volume administration, or the initial BP. In nine of the 15 infants with early-onset ICH, the hemorrhage progressed in severity during the first three postpartum days in association with increasing ventilatory requirements. The results of this study suggest that the course of labor may be a precipitating factor in the onset and evolution of early ICH.