Age is not the only risk factor in COVID-19: the role of comorbidities and of long staying in residential care homes

BACKGROUND

The actual SARS-CoV-2 outbreak caused a highly transmissible disease with a tremendous impact on elderly people. So far, few studies focused on very elderly patients (over 80 years old). In this study we examined the clinical presentation and the outcome of the disease in this group of patients, admitted to our Hospital in Rome.

METHODS

This is a single-center, retrospective study performed in the Sant'Andrea University Hospital of Rome. We included patients older than 65 years of age with a diagnosis of COVID-19, from March 2020 to May 2020, divided in two groups according to their age (Elderly: 65-80 years old; Very Elderly > 80 years old). Data extracted from the each patient record included age, sex, comorbidities, symptoms at onset, the Pneumonia Severity Index (PSI), the ratio of the partial pressure of oxygen in arterial blood (PaO2) to the inspired oxygen fraction (FiO2) (P/F) on admission, laboratory tests, radiological findings on computer tomography (CT), length of hospital stay (LOS), mortality rate and the viral shedding. The differences between the two groups were analyzed by the Fisher's exact test or the Wilcoxon signed-rank test for categorical variables and the Mann-Whitney U test for continuous variables. To assess significance among multiple groups of factors, we used the Bonferroni correction. The survival time was estimated by Kaplan-Meier method and Log Rank Test. Univariate and Multivariate logistic regression were performed to estimate associations between age, comorbidities, provenance from long-stay residential care homes (LSRCH) s and clinical outcomes.

RESULTS

We found that Very Elderly patients had an increased mortality rate, also due to the frequent occurrence of multiple comorbidities. Moreover, we found that patients coming from LSRCHs appeared to be highly susceptible and vulnerable to develop severe manifestations of the disease.

CONCLUSION

We demonstrate that there were considerable differences between Elderly and Very Elderly patients in terms of inflammatory activity, severity of disease, adverse clinical outcomes. To establish a correct risk stratification, comorbidities and information about provenience from LSRCHs should be considered.

Steroid biomarkers for identifying non-classic adrenal hyperplasia due to 21-hydroxylase deficiency in a population of PCOS with suspicious levels of 17OH-progesterone

OBJECTIVE

We aimed at defining the most effective routine immunoassay- or liquid chromatography-tandem mass spectrometry (LC-MS/MS)-determined steroid biomarkers for identifying non-classic adrenal hyperplasia due to 21-hydroxylase deficiency (21-NCAH) in a PCOS-like population before genotyping.

METHODS

Seventy PCOS-like patients in reproductive age with immunoassay-determined follicular 17OH-progesterone (17OHP) ≥ 2.00 ng/mL underwent CYP21A2 gene analysis and _1-24ACTH test. Serum steroids were measured by immunoassays at baseline and 60 min after ACTH stimulation; basal steroid profile was measured by LC-MS/MS.

RESULTS

Genotyping revealed 23 21-NCAH, 15 single allele heterozygous CYP21A2 mutations (21-HTZ) and 32 PCOS patients displaying similar clinical and metabolic features. Immunoassays revealed higher baseline 17OHP and testosterone, and after ACTH stimulation, higher 17OHP (17OHP₆₀) and lower cortisol, whereas LC-MS/MS revealed higher 17OHP (17OHP_LC-MS/MS), progesterone and 21-deoxycortisol and lower corticosterone in 21-NCAH compared with both 21-HTZ and PCOS patients. Steroid thresholds best discriminating 21-NCAH from 21-HTZ and PCOS were estimated, and their diagnostic accuracy in identifying 21-NCAH from PCOS was established by ROC analysis. The highest accuracy was observed for 21-deoxycortisol ≥ 0.087 ng/mL, showing 100% sensitivity, while the combination of 17OHP_LC-MS/MS ≥ 1.79 ng/mL and corticosterone ≤ 8.76 ng/mL, as well as the combination of ACTH-stimulated 17OHP ≥ 6.77 ng/mL and cortisol ≤ 240 ng/mL by immunoassay, showed 100% specificity.

CONCLUSIONS

LC-MS/MS measurement of basal follicular 21-deoxycortisol, 17OHP and corticosterone seems the most convenient method for diagnosing 21-NCAH in a population of PCOS with a positive first level screening, providing high accuracy and reducing the need for ACTH stimulation test.

Oxidovanadium(IV) complexes with chrysin and silibinin: anticancer activity and mechanisms of action in a human colon adenocarcinoma model

Vanadium compounds were studied during recent years to be considered as a representative of a new class of nonplatinum metal antitumor agents in combination to its low toxicity. On the other hand, flavonoids are a wide family of polyphenolic compounds synthesized by plants that display many interesting biological effects. Since coordination of ligands to metals can improve the pharmacological properties, we report herein, for the first time, a exhaustive study of the mechanisms of action of two oxidovanadium(IV) complexes with the flavonoids: silibinin Na₂[VO(silibinin)₂2]·6H₂O (VOsil) and chrysin [VO(chrysin)₂EtOH]₂(VOchrys) on human colon adenocarcinoma derived cell line HT-29. The complexes inhibited the cell viability of colon adenocarcinoma cells in a dose dependent manner with a greater potency than that the free ligands and free metal, demonstrating the benefit of complexation. The decrease of the ratio of the amount of reduced glutathione to the amount of oxidized glutathione were involved in the deleterious effects of both complexes. Besides, VOchrys caused cell cycle arrest in G2/M phase while VOsil activated caspase 3 and triggering the cells directly to apoptosis. Moreover, VOsil diminished the NF-kB activation via increasing the sensitivity of cells to apoptosis. On the other hand, VOsil inhibited the topoisomerase IB activity concluding that this is important target involved in the anticancer vanadium effects. As a whole, the results presented herein demonstrate that VOsil has a stronger deleterious action than VOchrys on HT-29 cells, whereby suggesting that Vosil is the potentially best candidate for future use in alternative anti-tumor treatments.

Experimental and simulative dissociation of dimeric Cu,Zn superoxide dismutase doubly mutated at the intersubunit surface

The equilibrium properties of dimeric Photobacterium leiognathi Cu,Zn superoxide dismutase mutant bearing two negative charges in the amino acid clusters at the association interface has been studied, experimentally and computationally, and compared to those of the native enzyme. Pressure-dependent dissociation is observed for the mutant, as observed by the fluorescence shift of the unique tryptophan residue located at the intersubunit surface. The spectral shift occurs slowly, reaching a plateau after 15-20 min, and is fully reversible. Measurement of the degree of dissociation allows us to calculate the standard volume variation upon association and the dissociation constant at atmospheric pressure. On the other hand the native protein is undissociable at any pressure. In the simulative approach, the dissociation free energy has been calculated through the blue moon calculation method for the case of a multidimensional reaction coordinate, corrected for the rotational contribution within the semiclassical approximation for a free rigid-body rotor. The scheme permits to define a definite path for the rupture of the dimer and to calculate the effective force involved in the process. The calculated free energy difference is close to the experimental one, and the value obtained for the mutant is well below that obtained for the native protein, indicating that the theoretical reaction scheme is able to reproduce the experimental trend. Moreover, we find that, when the separation distance increases, the protein structure of the monomer is stable in line with the fast recovery of the original fluorescence properties after decompression, which excludes the presence of partly unfolded intermediates during the dimer-monomer transition.

Active-site copper and zinc ions modulate the quaternary structure of prokaryotic Cu,Zn superoxide dismutase

The influence of the constitutive metal ions on the equilibrium properties of dimeric Photobacterium leiognathi Cu,Zn superoxide dismutase has been studied for the wild-type and for two mutant protein forms bearing a negative charge in the amino acid clusters at the dimer association interface. Depletion of copper and zinc dissociates the two mutant proteins into monomers, which reassemble toward the dimeric state upon addition of stoichiometric amounts of zinc. Pressure-dependent dissociation is observed for the copper-depleted wild-type and mutated enzymes, as monitored by the fluorescence shift of a unique tryptophan residue located at the subunit association interface. The spectral shift occurs slowly, reaching a plateau after 15-20 minutes, and is fully reversible. The recovery of the original fluorescence properties, after decompression, is fast (less than four minutes), suggesting that the isolated subunit has a relatively stable structure, and excluding the presence of stable intermediates during the dimer-monomer transition. The dimer dissociation process is still incomplete at 6.5 kbar for the copper-depleted wild-type and mutated enzymes, at variance with what is generally observed for oligomeric proteins that dissociate below 3 kbar. Measurement of the degree of dissociation, at two different protein concentrations, allows us to calculate the standard volume variation upon association, Delta V, and the dissociation constant K(d0), at atmospheric pressure, (25 ml/mol and 3 x 10(-7)M, respectively). The holoprotein is fully dimeric even at 6.5 kbar, which allows us to evaluate a lower Delta G degrees limit of 11.5 kcal/mol, corresponding to a dissociation constant K(d0)<10(-9)M.

Specific combinations of zein genes and genetic backgrounds influence the transcription of the heavy-chain zein genes in maize opaque-2 endosperms

The transcript levels of heavy-chain zein genes (zH1 and zH2) and the occurrence of the zH polypeptides in different opaque-2 (o2) lines were investigated by RNA-blot analyses and by sodium dodecylsulfate-polyacrylamide gel electrophoresis or two-dimensional gel electrophoresis protein fractionations. Four mutant alleles o2R, o2T, o2It, and o2-676 introgressed into different genetic backgrounds (GBs) were considered. The mono-dimensional gel electrophoresis zein pattern can be either conserved or different among the various GBs carrying the same o2 allele. Likewise, in the identical GB carrying different o2 alleles, the zein pattern can be either conserved or differentially affected by the different mutant allele. Zein protein analysis of reciprocal crosses between lines with different o2 alleles or the same o2 showed in some case a more than additive zH pattern in respect to the o2 parent lines. Electrophoretic mobility shift assay approaches, with O2-binding oligonucleotide and endosperm extracts from the above o2 lines, failed to reveal o2-specific retarded band in any of the o2 extracts. The results suggest that the promoter of some zH1 and zH2 contains motif(s) that can respond to factors other than O2.

[The effectiveness and acceptance of a medical device for the treatment of aphthous stomatitis. Clinical observation in pediatric age]

BACKGROUND

To evaluate the efficacy of a new bioadhesive patch, Aloe vera hydrogel, for the treatment of aphthous stomatitis.

METHODS

An open, not controlled study was performed in 31 pediatric out-patients, aged 6-14 years, affected by mouth ulcers were enrolled consecutively in the 3 Gps Depts+ of San Marino Republic. For each case, data on case history and clinical profile, patterns of the lesion, presence of spontaneous or provoked pain were collected at baseline, and a bioadhesive patch ("Alovex patch") was administered on the basis of a daily regimen of < or = 3 patches for 4 days. Data on modification of the above-mentioned parameters, with patients and physicians opinion on the therapeutical efficacy, were collected during a control visit (4 days later). Moreover, by means of a daily diary, patients recorded information on the course of the symptoms during the 4 days and were also asked to compare the current treatment with other previous therapies.

RESULTS

At the control visit 77% of the patients have shown a marked resolution of spontaneous pain, while in the other patients, pain was significantly decreased to a "mild" or "moderate" level. No one child declared to suffer from severe pain. Also provoked pain resulted to be significantly decreased after treatment Global efficacy was judged positively, being the therapeutical effect in more than 80% of cases "evident or of absolute improvement" both by physicians and patients opinion. A positive improvement of symptomatology started within the 2nd day of treatment in 74% of the patients. The compliance (adhesivity, acceptability and palatability) of the formulation was judged largely favourable in more than 90% of the patients.

CONCLUSIONS

The results of this study underline the good efficacy and compliance of the patch for the treatment of the aphtous stomatitis; also the limit of topical available therapies, linked to the "contact time", to develop their therapeutical action, seems not to be evinced on the basis of this study, so the application of this patch seems to be more easy and beneficial.

[Syncopal pathology in childhood (I)]

Syncope is a common phenomenon, well-known to all pediatricians: it is defined as a sudden transient loss of consciousness associated with inability to maintain postural tone that is incompatible with a seizure disorder, vertigo, dizziness, coma, shock or other states of altered consciousness. The purpose of this study are to analyse the multiple causes of syncope, to determine the characteristics of pediatric patients with syncope, to define the pathophysiologic mechanisms that result in neurally mediated syncope.

[Postpartum myoglobin blood monitoring in newborns. Correlations with renal function in the first 48 hours of life]

BACKGROUND

Myoglobin is a muscular tissue protein, and it is a very early damage index. As the newborn "thin mass" is less than that of the adult and knowing the renal dynamics of this protein clearance, the authors have analyzed the correlation between myoglobinemia and transitory renal failure, which is frequently present in newborns with fetal distress.

METHODS

We examined a random population of 56 newborns (33 eutocic deliveries 14 caeserotomy, 9 various degrees of fetal distress) to which, after having had the parents' informed consent, the microsamples pattern was fixed at 0, 6, 12, 24, 48 hours from birth at the same time of ordinary exams to gauge: myoglobin with nephelometric method, CPK, creatininemia, azotemia and transaminase. The same exams were camed out on the mother at the beginning of labor and after delivery.

RESULTS

We found that the placenta is not permeable to mother myoglobin, at the sixth hour from birth we have the highest value, while CPK is lower to increase, myoglobinemia associated with myoglobin variations.

CONCLUSIONS

Myoglobinemia might be monitored to prevent distressed newborns from transitory renal tubular defect, justifying forced diuresis and urinary alkalosis.

Effect of patient characteristics on hospital costs for cirrhosis: implications for the disease-related group (DRG) reimbursement system

The Prospective Payment System uses Diagnosis-Related Groups (DRG) as a reimbursement system. DRG 202 is a disease-related group including liver cirrhosis as a whole. Patients referring to the inpatient unit complain of variable severity and complications of cirrhosis, possibly implying different expenditure of resources. Aim of the investigation was to identify factors affecting cost variability in patients with cirrhosis. A total of 73 consecutive, DRG 202-assigned, cirrhotic patients classified according to demographic and clinical variables were evaluated for length and costs of hospitalization calculated on a full-cost basis. Mean length of hospitalization was 10.2 +/- 7 days. Mean cost of hospitalization was Lit. 4.348.000 +/- 2.718.000. Medical, nursing, diagnostic, drug and general charges accounted for 13%, 29%, 37%, 5% and 16% of the cost, respectively. Child-Pugh score significantly correlated with drug consumption (p < 0.005), length (p < 0.01) and costs (p < 0.001) of hospitalization, but not with cost per day. Age, sex, admission status, referral reason, associated diseases and liver transplant susceptibility did not correlate with duration and costs of hospitalization. Disease severity significantly modifies costs of hospital admission in cirrhotic patients mostly on account of longer hospital stay. Surrogate indexes of disease severity, derived from ISTAT/DRG records, cannot identify patients consuming larger resources. In liver cirrhosis, the DRG system could be improved by introducing parameters, such as Child-Pugh score, directly taking into account disease severity.

Relationship between hydration of lean body mass and visceral adipose tissue. A clinical study of women

OBJECT

To study the relationship between hydration of lean body mass and adipose tissue location.

DESIGN

Cross-sectional, clinical study of visceral adipose tissue area and total body water as a percentage of lean body mass.

PATIENTS

Seventy-two adult, overweight, women, 52 pre- and 20 post-menopausal (age: 18-72 years, body mass index: 26-52).

MEASUREMENTS

Total body water was obtained by electrical impedance measurement; visceral adipose tissue and lean body mass were obtained by computed tomography measurement of visceral adipose tissue area at the level of the 4th-5th lumbar vertebra.

RESULTS

Visceral adipose tissue was found, by multiple regression analysis, to be the only predictor of the hydration of the lean body mass. The other independent variables: age, menopausal status, body mass index, glucose and insulin both fasting and after glucose load were not able to significantly improve the predictive power.

CONCLUSION

Results of this study confirm the existence of a relationship between visceral adipose tissue content and hydration of the lean body mass.

[Assessment of lead blood levels in children living in Lucca (Italy) in 1993. The study was conducted as part of the project METOS, in accordance with the decree 496 of June 1982 which adopted the directive CEE No.77/312]

OBJECTIVE

Lead poisoning is a major cause of environmental concern in all countries worldwide. Saturnism in children, especially if young and neglected, represents a peculiar phenomenon both in terms of the biology of growing subjects and the epidemiological nature of poisoning. In under five-year-olds, in addition to lead levels in the atmosphere, it is equally important to evaluate the presence of contaminated dust in the house, hand-to-mouth activities and the level of care provided by parents. It has been demonstrated that, in the presence of equivalent environmental lead levels, dust removal from the house and prevention of hand-to-mouth activities can successfully reduce lead blood levels (PbB) in children.

AIM

The aim of this study was to evaluate the risk of chronic lead poisoning in children attending Local Health Unit 6 in Piana di Lucca and to assess the need for a possible health education campaign aimed at eliminating the specific pediatric risk for lead poisoning.

MATERIALS AND METHODS

Assay of lead blood levels in 172 children from 0 to 14 years old consecutively attending the Emergency Ward at Campo di Marte Hospital in Lucca for reasons not relating to lead poisoning.

RESULTS

Mean lead blood levels in children were 57.2 +/- 30.2 mg/l (mean 50 mg/l) without significant differences between the various age brackets (0-5, 6-10, 11-14 years old). Only one child presented pathological PbB levels (280 mg/l when first measured; 360 mg/l a few months later with normal values of erythrocytic Zn-protoporphyrin, 24-h urinary lead excretion and 24-h urinary delta-aminolevulinic acid). An epidemiological study is now being made of the causes. The general population within the same area presented mean PbB levels of 70.4 +/- 36.9 mg/l (mean 60 mg/l), measured in a total of 471 subjects (adults and children).

DISCUSSION AND CONCLUSIONS

The PbB levels currently found in children resident in Lucca confirm a low-risk environmental situation. Preventive measures specifically aimed at children do not therefore appear to be justified at present.

Measured and predicted total and visceral adipose tissue in women. Correlations with metabolic parameters

The aim of this study was the verification of the clinical utility of predictive equations for total and intra-abdominal adipose tissue areas. Formulas were calculated using computed tomography (CT) as the gold standard. Ninety-three females were randomly divided into two groups. The predictive equation group was used to calculate the predictive equations for computed tomography adipose tissue areas at the L4-L5 level. These equations were then used to predict total and intra-abdominal adipose tissue area in the validation group. Correlations were made between metabolic parameters and both measured and calculated areas and single predictors. The following measurements were carried out: age, weight/height ratio, body mass index, waist, hip, waist/hip ratio, ultrasound measurement of intra-abdominal distance between abdominal muscle and aorta, sagittal abdominal diameter by CT, adipose tissue intra-abdominal area by CT, total abdominal adipose tissue area by CT. Blood glucose and insulin both fasting and after glucose load. Fasting cholesterol and triglycerides. The best predictors of total and visceral adipose tissue areas were, respectively: weight/height ratio and ultrasound intra-abdominal measurement. Correlations between metabolic parameters and adipose tissue areas both as measured and as calculated by predictive equations were quite similar. Correlations between metabolic parameters and single best predictors of measured adipose tissue areas also gave the same results. Some simple and safe anthropometric measurements can be used, instead of total and visceral adipose tissue area as assessed by CT, when studying associations between adipose tissue and metabolic parameters on sufficiently large groups of patients.

Familial infantile myasthenia: a neuromuscular cause of respiratory failure

Acute respiratory failure can be the product of any of a great number of muscular, neuromuscular, and neurologic causes. The family history may be extremely helpful in narrowing the differential diagnosis. We report the case of a girl who, during the course of a slight upper respiratory infection, presented with acute respiratory failure requiring mechanical ventilation. The family history was significant for a brother who had arthrogryposis and died at 15 h of life, also from respiratory failure. The patient herself had a history of palpebral ptosis in the evening. The absence of electromyographic and muscle biopsy abnormalities and the patient's positive response to anticholinesterase therapy supported the diagnosis of familial infantile myasthenia. We emphasize the importance of considering the myasthenic syndromes in the differential diagnosis of acute respiratory failure, since appropriate therapy can rapidly resolve the symptoms. Furthermore, an accurate diagnosis allows appropriate genetic counseling for the hereditary forms.

Interrelationships between intraabdominal fat and total serum testosterone levels in obese women

Thirty-six women aged 18 to 52 years with body mass indexes (BMIs) between 27 and 52 were studied. Visceral and subcutaneous fat areas and body fat were evaluated by computerized tomography with a single scan at the IV-V lumbar vertebra level. Glucose, insulin, and C-peptide levels were measured before and after a glucose load. Total and free serum testosterone and 24-hour urinary cortisol excretion were measured. A stepwise multiple regression equation showed the visceral to subcutaneous fat area ratio to be the most powerful predictor for glucose alterations both during fasting and after a glucose load, and showed BMI to be the most powerful predictor for insulin and C-peptide levels. Total serum testosterone, after matching for age and BMI, demonstrates a significant negative correlation with visceral fat area. We conclude that in obese women, as in men, intraabdominal fat negatively correlates with serum testosterone levels.

[Magnesium in the prophylaxis of primary headache and other periodic disorders in children]

Migraine has been recently defined a "central neuronal hyperexcitability state", maybe magnesium-dependent, and magnesium has been occasionally employed in the therapy of adult migraine. The Authors, on the basis of their personal experience (previous electromyographic studies), consider childhood migraine and periodic syndrome as a clinical equivalent of spasmophilia, in which an intracellular deficit of magnesium has been demonstrated, and have employed a magnesium salt in the prophylaxis of childhood migraine and migraine equivalents. 40 children with periodic syndrome (17 M and 23 F, aged 10.4 +/- 2.9 years) have been treated with magnesium pidolate, with doses ranging from 1.5 g/die to 4.5 g/die (corresponding to 122-366 mg Mg++):25 of them presented migraine as the main symptom, 12 recurrent abdominal pain, 3 fever of unknown origin, along with many other periodic symptoms. The first control visits have been done at 1 month, clinical follow-up lasted a mean period of 6.1 months. Therapy was stopped at 1 month visit if ineffective (of some other drug was added); otherwise, magnesium therapy was continued with the same dosage for another month, then gradually reduced. Clinical response was considered good if crises ceased completely or their frequency was reduced to less than 33%; partial if reduced to less than 67% of previous incidence; absent if only slightly or not at all reduced. Clinical response was good in 72.5% of cases at 1 month, in 77.5% later; partial in 12.5% and 10%; absent in 15% and 12.5% respectively. No side effects were observed. The compliance of children and their families was complete.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tests of autonomic nervous system functioning in children: normal values]

The study of cardiovascular autonomic reflexes is the most physiological and reliable test for the assessment of autonomic function: they consist of the analysis of variation of heart rate and arterial pressure provoked by many physiological stimuli. Up to now normal pediatric reference data were not available: we have standardized these tests in 198 normal children (94 M, 104 F), aged 8.3-15.7 years, without any symptom of possible autonomic dysfunction pathology. A complete auxological evaluation has been performed. Autonomic tests were performed by ECG recording and arterial pressure monitoring during normal and deep breathing, Valsalva manoeuvre, lying to standing postural change, isometric muscular contraction (sustained hand-grip and leg rising). Eleven autonomic parameters were obtained. Many statistical correlation between autonomic parameters and auxological features have been explored, without remarkable results. A significative difference emerged only between sexes. Normal reference values has been calculated. Their utility for the study of autonomic dysfunction is discussed.

[Autonomic neural functioning in children with the periodic syndrome]

The pathogenesis of periodic syndrome (recurrent abdominal pain, cyclic vomiting, headache and other equivalents of childhood migraine) is often related in the literature to a "neuro-vegetative dysfunction", by which occasional stimuli (environmental, metabolic, emotional) should find a particular somatic expression. The homeostatic role of the autonomic nervous system could be deficient in these cases, but systematic research has never been done to explore this hypothesis. We have evaluated the autonomic nervous function in 38 children (12 M, 26 F) with periodic syndrome, by cardiovascular autonomic function tests. They consist of ortho- and parasympathetic parameters obtained by ECG registration and pressure monitoring during deep breathing, Valsalva manoeuvre, lying to standing postural change, sustained handgrip. In the absence of adequate pediatric references values, we have previously standardized these tests in a population of 198 healthy children (94 M, 104 F), aged 8.3-15.7 years. Results have been compared with our standard reference values, matching them by t-test for independent data: in both sexes, significant differences have been found out in only one of 11 parameters (p < 0.05) of the autonomic tests performed. Children affected by periodic syndrome reveal a reduced heart rate variation in transition from the early orthosympathetic phase to the late parasympathetic one after lying to standing passage, showing a smaller fluctuation of autonomic feedback systems. The physiological meaning of this result is unclear. However, in children with periodic syndrome no prevalence of ortho- or parasympathetic systems is evident.

Resting metabolic rate, body-fat distribution, and visceral fat in obese women

Resting metabolic rate (RMR) was evaluated in 27 obese women aged 16-49 y [body mass index (in kg/m2) 27-51] by indirect calorimetry. Visceral and subcutaneous adipose tissue areas, body fat, and fat-free mass (FFM) were measured by a single scan with computed tomography (CT); the waist-hip circumference ratio (W/H) was also used. Comparison between the lowest and the highest RMR quartiles--adjusted for age and FFM--revealed a higher W/H in the highest quartile (0.78 +/- 0.08 vs 0.88 +/- 0.08; P < 0.05). No difference was observed in CT indexes. No differences in W/H were observed after RMR was adjusted for age, FFM, and body fat. Our results point out that RMR, adjusted for FFM and age, correlates with body-fat distribution as evaluated by W/H, but not with visceral fat, as evaluated by CT. Correlations disappeared after RMR was adjusted for body fat as well.

[Fever as periodic disorder]

Slight, moderate but also high rises in temperature, excluding other causes of fever, can be considered symptoms of periodic syndrome originating by hypothalamic centers as soon as headache, recurrent abdominal pains, growing pains, dizziness, kinetosis. These rises aren't uncommon, but often aren't considered important and this few statistics are available. The Authors present 16 case reports of fever as periodic symptom and discuss how common factors exist in the mechanism of hyperthermia and other clinical signs of periodic syndrome (ex. migraine) but they are generally modulated differently so that disturbance of temperature regulation predominates in the first case, pain in the second.

[Comparison of periodic syndrome and spasmophilia]

Two casual clinical observations here reported allow the Authors to discuss the possible relationships between periodic syndrome and spasmophilia. Particularly they stress how these common causes of recurrent symptoms (abdominal pain, headache, growing pains, anxiety, irritability) can be the same clinical entity. This suspicion is confirmed by EMG investigation: 25 children with periodic syndrome (8 males, 17 females; 8-13 years) and 10 normal subjects (6-11 years) participate in this study. Post-ischemic EMG shows signs of neuromuscular hyperexcitability as in spasmophilia in 21 children (84%) of the first group and only in 3 of the second group. Such findings should be regarded as the first step towards a better definition of the relationships between periodic syndrome and spasmophilia.

[A diagnostic controversy: the significance of 14-6/sec positive spikes in clinical electroencephalography]

There has been a great dealt of discussion as to the clinical significance of E.E.G. 14-6 per second positive spikes (14-6 PS), a short burst lasting one second or less which occurs during light sleep in monopolar recordings, mainly in the posterior temporal regions and usually involving the parietal and occipital regions as well, for the most part in unsymmetrical fashion. Early interpretations stress the epileptic nature of vegetative attacks in patients with an inter-critical E.E.G. reading characterized by 14-6 P.S. Subsequently, however, this hypothesis has been refuted, mainly because E.E.G. intra-critical recordings have never shown evidence of any sort of paroxysmal activity. At present time expert think that the presence of 14-6 PS may be merely an indication of an electrical alteration associated with disorders in the neurovegetative area. In order to evaluate the possibility of using them as a diagnostic marker of migraine equivalents and periodic syndromes, we reviewed wake and sleep E.E.G. recordings, carried out consecutively and hence not selectively, in 617 children aged 5-16 years. 14-6 PS were present in 109 children (17.6%), 63 of whom showed evident symptoms of periodic syndrome (headache, recurrent abdominal pain, cyclic vomiting, kinetosis, etc.); hence 46 E.E.G. recording were false positive. 510 children were lacking in 14-6 PS, 91 of these presented symptoms of periodic syndromes (false negative). 14-6 PS are hence a marker 40.9% sensitive, 90.1% specific, with a predictable value of 57.7%. The search for 14-6 PS in children with periodic syndrome is not particularly sensitive as a test, but it is fairly specific: it may well constitute an useful element in diagnosis.

[Velo-cardio-facial syndrome (Shprintzen syndrome)]

A patient with the velo-cardio-facial syndrome is described. The most frequent features include cleft palate, cardiac anomalies, typical facies, and learning disabilities. Less frequent findings include microcephaly, mental retardation, small stature, slender hands and digits, minor auricolar anomalies, and inguinal hernia. There were four instances of familial transmission in the 39 patients of the literature.

[Non-immunologic hydrops fetalis. Considerations apropos of a case associated with a chorioangioma of the placenta]

A case of hydrops fetalis in a newborn infant in association with a choroangioma of the placenta in described. It was only with a report in 1943 by Potter that nonimmunologic hydrops fetalis was identified. Until recently immunologic hydrops fetalis secondary to Rh incompatibility has been the most frequent cause for infants with this condition. Presently, because of the decline in the incidence of Rh sensitization, non immunologic hydrops fetalis accounts for a larger number of cases. Numerous etiologies have been reported with the occurrence of non immunologic hydrops fetalis: a review of the literature for those entities found in association with this condition is inclused.

The effects of eledoisin on intestinal smooth muscle of ruminants

The effects of eledoisin on the intestinal smooth muscle of ruminants are reported. The results obtained on isolated in vitro preparations from cattle suggest a direct effect of the peptide on the smooth muscle of the different intestinal sections examined. The observations made during in vivo experiments on sheep suggest that eledoisin produces its effects by also affecting the autonomic nerve supply to the intestine of these animals.