Spontaneous Evolution of COVID-19 Lung Sequelae: Results from a Double-Step Follow-Up

Background

Few studies have reported a double-step follow-up of patients after hospitalization for COVID-19.

Objectives

We designed an observational double-step follow-up study with a clinical, functional, and radiological evaluation at 2 and 6 months after COVID-19. The primary outcome was to describe symptoms, spirometry, and 6-minute walking test (6MWT) at 2 and 6 months. Secondary outcomes were to identify if the lowest PaO₂/FiO₂ during hospitalization is related with functional and radiological evolution and to assess the correlation between radiological and functional abnormalities at 6 months.

Methods

Symptoms, spirometry, and 6MWT were assessed at 2 and 6 months; arterial blood gas, chest x-ray, and lung ultrasound were performed at 2 months; body plethysmography, diffusing capacity for carbon monoxide (DLCO), and CT scan were performed at 6 months.

Results

Sixty-four per cent and 42% of patients reported at least one symptom at 2 and 6 months, respectively. The most common 6-month functional alteration was DLCO impairment (57% of patients). An improvement of FEV1, FVC, and 6MWT was observed between 2 and 6 months (p < 0.001). Patients with PaO₂/FiO₂ <200 during hospitalization performed worse at 6MWT at 2 and 6 months (p < 0.05) and reported more extended radiological abnormalities at 6 months (p < 0.001) compared with patients with PaO₂/FiO₂>200. At 6 months, more extended radiological abnormalities were related with worse 6MWT, DLCO, and total lung capacity (p < 0.05).

Discussion

DLCO and 6MWT impairment seem to be the functional hallmark of COVID-19 and are related with the severity of acute pneumonia. At 6 months, radiological abnormalities were related to functional impairment.

Interobserver agreement between pathologist, pulmonologist and molecular pathologist to estimate the tumour burden in rapid on-site evaluation smears from endosonography and guided bronchoscopy

OBJECTIVE

A growing number of studies have suggested that non-pathologists can reliably assess the adequacy and malignancy in rapid on-site evaluation (ROSE) smears prepared during endoscopic sampling procedures. However, no study has verified whether they can also consistently estimate the tumour burden, which is critical for the molecular profiling of lung cancer. We aimed to assess the interobserver agreement (IOA) between a pathologist, a pulmonologist (previously trained in lung and lymph node cytopathology) and a molecular pathologist for the tumour burden in ROSE smears.

METHODS

The ROSE smears of consecutive patients with suspected lung cancer undergoing endosonography or guided bronchoscopy were assessed independently by a pathologist, a pulmonologist and a molecular pathologist (gold standard). The IOA for the tumour burden, assessed through k-statistics, was the primary outcome.

RESULTS

A total of 322 ROSE smears obtained from 162 patients were evaluated. The IOA between the molecular pathologist and pulmonologist was very good (moderate to substantial), although slightly inferior to the IOA between the molecular pathologist and pathologist in the whole slide set (k: 0.707, 95% confidence interval [CI]: 0.677-0.739 vs 0.793, 95% CI: 0.762-0.815), as well as in smears prepared from lymphadenopathy (k: 0.783, 95% CI: 0.760-0.855 vs 0.827, 95% CI: 0.728-0.892) or from pulmonary nodules/masses (k: 0.558, 95% CI: 0.416-0.686 vs 0.715, 95% CI: 0.621-0.767).

CONCLUSIONS

A professionally trained pulmonologist can reliably estimate the tumour burden in bronchoscopically derived ROSE smears, especially in the setting of lymphadenopathy. This can be particularly useful in institutions where a cytopathologist is not available regularly.

Diagnosis and Molecular Profiling of Lung Cancer by Percutaneous Ultrasound-Guided Biopsy of Superficial Metastatic Sites Is Safe and Highly Effective

BACKGROUND

Diagnosis, staging, and molecular profiling of lung cancer are mostly carried out with bronchoscopy or CT-guided aspiration/biopsy. However, patients with locally advanced or advanced disease often harbor "superficial" metastases for which a percutaneous, ultrasound-assisted needle aspiration/biopsy (US-NAB) might represent an equally effective yet less invasive and costly alternative.

PATIENTS AND METHODS

We reviewed a prospectively collected database of consecutive patients with known/suspected lung cancer who underwent a US-NAB of a suspected "superficial" metastasis. Cancer genotyping was carried out with next-generation sequencing using the Oncomine™ Focus DNA and RNA fusion panels. PD-L1 immunohistochemistry was performed with the SP263 antibody. Feasibility, diagnostic yield for tissue diagnosis, sensitivity for malignancy, diagnostic yield for the molecular profiling, and complications were the study endpoints.

RESULTS

A total of 98 lesions were evaluated, and 93 were biopsied (95% feasibility). The spectrum of sampled sites included lymph nodes (63 patients), bone (11), subcutaneous tissue (8), muscle (7), and the pleura (4). The diagnostic yield for a tissue diagnosis was 93% (91/98). US-NAB correctly identified 85 of the 87 patients finally diagnosed with malignancy (98% sensitivity). Cancer genotyping and PDL1 testing were successfully completed in 41/42 patients (98%) and in 40/50 patients (80%) for whom these tests were requested, respectively. No complications were observed.

CONCLUSION

US-NAB of "superficial" metastasis of lung cancer is safe and is associated with high success for diagnosis and molecular profiling. In this clinical setting, using US-NAB as a first-step technique would significantly limit the use of more invasive and costly diagnostic procedures.

Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study

BACKGROUND

Persistent hypercapnia after COPD exacerbation is associated with excess mortality and early rehospitalization. High Flow Nasal cannula (HFNC), may be theoretically an alternative to long-term noninvasive ventilation (NIV), since physiological studies have shown a reduction in PaCO2 level after few hours of treatment. In this clinical study we assessed the acceptability of HFNC and its effectiveness in reducing the level of PaCO₂ in patients recovering from an Acute Hypercapnic Respiratory Failure (AHRF) episode. We also hypothesized that the response in CO₂ clearance is dependent on baseline level of hypercapnia.

METHODS

Fifty COPD patients recovering from an acute exacerbation and with persistent hypercapnia, despite having attained a stable pH (i.e. pH > 7,35 and PaCO₂ > 45 mmHg on 3 consecutive measurements), were enrolled and treated with HFNC for at least 8 h/day and during the nighttime RESULTS: HFNC was well tolerated with a global tolerance score of 4.0 ± 0.9. When patients were separated into groups with or without COPD/OSA overlap syndrome, the "pure" COPD patients showed a statistically significant response in terms of PaCO₂ decrease (p = 0.044). In addition, the subset of patients with a lower pH at enrolment were those who responded best in terms of CO₂ clearance (score test for trend of odds, p = 0.0038).

CONCLUSIONS

HFNC is able to significantly decrease the level of PaCO₂ after 72 h only in "pure" COPD patients, recovering from AHRF. No effects in terms of CO2 reduction were found in those with overlap syndrome. The present findings will help guide selection of the best target population and allow a sample size calculation for future long-term randomized control trials of HFNC vs NIV.

TRIAL REGISTRATION

This study is registered with www. clinicaltrials.gov with identifier number NCT03759457.

Noninvasive ventilation and renal replacement therapy in do-not-intubate order critically ill patients: A brief report

INTRODUCTION

Multiple organ failure has been considered a contraindication for noninvasive ventilation (NIV).

MATERIALS AND METHODS

We described the outcome of Do-not-Intubate (DNI) patients with acute respiratory failure, treated with NIV and, subsequently, necessitating renal replacement therapy (RRT).

RESULTS AND DISCUSSION

Seven patients admitted to our Respiratory Intensive Care Unit, developed Acute Kidney Injury (AKI) during NIV treatment and received RRT for 12.8 ± 8 days together with NIV. All the patients but one, discontinued renal support because they regained a satisfactory urinary output; nevertheless mortality rate was high (71%).

CONCLUSION

Our data suggest that RRT could be feasible together with NIV. RRT was associated with an acute improvement in renal function but did not modify the mortality rate.

Development of a Novel Wearable Ring-Shaped Biosensor

We report on the preliminary results obtained out of a wearable module designed to be encompassed within a ring-shaped system aimed at providing healthcare services. The module is composed of two sensors for the measuring of Galvanic Skin Response (GSR) and Heart Rate Variability (HRV). A first device validation was carried out by involving four subjects who were asked to perform tasks providing different stress-related statuses. A comparison of physiological parameters measured by the module with those measured by a commercial HRV-GSR sensor chosen as gold standard was made. Two out of the three HRV parameters and all of the GSR parameters measured with the module resulted consistent (mostly differing less than 10%) with the same parameters measured by the gold standard. The work reported in this paper set a milestone for the realization of a system exploiting sensor fusion to provide active ageing, stress detection, activity recognition and e-health services has been achieved.

Rapid Diagnosis of Bacterial Contamination of Blood: Comparison of Three Automated Microbial Detection Systems

Rapid methods of determining microbial contamination are needed in suspecting contaminated banked blood or other blood products. In this study, we experimented contaminated blood units with 122 strains of bacteria and fungi. After innoculation, a comparison between ESP Blood Culture Sytem (Difco Laboratories Inc., Detroit Ml), BacT/Alert (Organon Teknica, Durham NC) and Bactec 9240 System was made for their efficiency in the detection of microbial contamination. Experimental data showed a diagnostic relevance of these automated systems with no significant differences in time detection of microbial contamination between the three methods under comparison.

Splanchnic vein thrombosis in myeloproliferative neoplasms: risk factors for recurrences in a cohort of 181 patients

We retrospectively studied 181 patients with polycythaemia vera (n=67), essential thrombocythaemia (n=67) or primary myelofibrosis (n=47), who presented a first episode of splanchnic vein thrombosis (SVT). Budd–Chiari syndrome (BCS) and portal vein thrombosis were diagnosed in 31 (17.1%) and 109 (60.3%) patients, respectively; isolated thrombosis of the mesenteric or splenic veins was detected in 18 and 23 cases, respectively. After this index event, the patients were followed for 735 patient years (pt-years) and experienced 31 recurrences corresponding to an incidence rate of 4.2 per 100 pt-years. Factors associated with a significantly higher risk of recurrence were BCS (hazard ratio (HR): 3.03), history of previous thrombosis (HR: 3.62), splenomegaly (HR: 2.66) and leukocytosis (HR: 2.8). Vitamin K-antagonists (VKA) were prescribed in 85% of patients and the recurrence rate was 3.9 per 100 pt-years, whereas in the small fraction (15%) not receiving VKA more recurrences (7.2 per 100 pt-years) were reported. Intracranial and extracranial major bleeding was recorded mainly in patients on VKA and the corresponding rate was 2.0 per 100 pt-years. In conclusion, despite anticoagulation treatment, the recurrence rate after SVT in myeloproliferative neoplasms is high and suggests the exploration of new avenues of secondary prophylaxis with new antithrombotic drugs and JAK-2 inhibitors.

Therapeutic implications of adding the psychotropic drug escitalopram in the treatment of patients suffering from moderate-severe psoriasis and psychiatric comorbidity: a retrospective study

BACKGROUND

It is known that stress and/or psychiatric diseases can play an important role in determining psoriasis, including the well-known negative somato-psychiatric rebound that comes with the disease.

METHODS

Samples of 38 subjects suffering from both moderate-severe psoriasis treated with anti-TNFα, and depressive and/or anxious mood disorders were studied. Part of them were additionally treated with escitalopram, whereas the other group only consulted to a dermatological and psychiatric follow-up. The aim of this study was to determine if an improvement in the dermatological manifestation as well as an improvement in the anxious-depressive disorder can be observed.

RESULTS

The study revealed that patients treated with escitalopram had a reduction of psycho-diagnostic test scores that measure depression and anxiety levels as well as the values of pruritus.

CONCLUSION

Our study suggests that psychological interventions and antidepressant medications may improve perceived symptom severity, quality of life and major compliance to the treatment in selected patients (suffering from psoriasis and mood disturbance), without a clinician necessarily being able to see an impact on psoriasis severity.

The importance of stressful family events in psoriatic patients: a retrospective study

BACKGROUND

Psychosomatic stress events are believed to play an important role in psoriasis either by inducing or worsening the disease.

OBJECTIVE

In this article, we compared the role of family stress events against other types of stress events on the psychological well being of patients and on their skin disease. We used our sample of psoriasis patients with said stress events.

METHOD

Patients underwent a dermatological examination which was evaluated through the PASI index. Simultaneously, they underwent interviews for psychological evaluations. The Hamilton scales were administered to assess anxiety and depression (Ham-A scores significant >20, Ham-D >15).

RESULTS

It has been demonstrated that family stress influences the psychological well being more than other types of daily stress events. In fact, people with family stress events reported higher value HAM-A (P = 0.03) and HAM-D (P = 0.02) compared with those who reported other types of stress events. Women reported higher values of HAM-A and HAM-D than men. The value of PASI in the two groups (with family stress events and those with other stress events) was not statistically significant.

CONCLUSION

Results obtained from this analysis show the importance of family stress events on the quality of life and on psychiatric and dermatological status. For the psychological morbidity, a parallel approach of both bio-psychiatric and skin care is recommended, especially for women.

Scabies: should we always perform dermatoscopy?

The authors describe a case of scabies in a 80 year-old woman with a history of intense itching. Lesions were not present in the body parts where they usually occur, but few erythematous and papular lesions were visible on the rear trunk. Diagnosis was not based on the usual clinical features or on the traditional method of microscopic examination but a high magnification videodermatoscopy was performed and, on a burrow-like scabby lesions at the rear trunk, a mite was found. This paper focuses on the importance of the videodermatoscopy, a simple, quick, non-expensive and non-invasive technique, that enhances the diagnostic capability in a case of scabies, which is not localized in the characteristic zones.

Tracking propagation of ultrashort intense laser pulses in gases via probing of ionization

We use optical interferometry to study the propagation of femtosecond laser pulses in gases. We show the measurements of propagation in a nitrogen gas jet and we compare the results with propagation in He under the same irradiation conditions. We find that in the case of nitrogen, the detailed temporal structure of the laser pulse can be tracked and visualized by measuring the phase and the resulting electron-density map. A dramatically different behavior occurs in He gas jets, where no details of the temporal structure of the laser pulse are visible. These observations are explained in terms of the ionization dynamics of nitrogen compared to helium. These circumstances make N2 gas sensitive to variations in the electric field and, therefore, allow the laser-pulse temporal and spatial structures to be visualized in detail.

Charged state of a spherical plasma in vacuum

The stationary state of a spherically symmetric plasma configuration is investigated in the limit of immobile ions and weak collisions. Configurations with small radii are positively charged as a significant fraction of the electron population evaporates during the equilibration process, leaving behind an electron distribution function with an energy cutoff. Such charged plasma configurations are of interest for the study of Coulomb explosions and ion acceleration from small clusters irradiated by ultraintense laser pulses and for the investigation of ion bunches propagation in a plasma.

Attitudes towards menopause in a group of women followed in a public service for menopause counseling

This preliminary study addressed some specific attitudes towards menopause, and behavioral styles in menopausal women. The study was conducted during the period January-May 1998 at the Menopausal Service of the Magenta Hospital (Milano) in 88 women, representing almost one half of the patients followed during that period; 43 women were treated with HRT. Some traits characterizing women's life during menopause were examined, such as presence of disturbing physical symptoms, changes in interests and discovery of new interests, and feelings of loss and uselessness. We used different psychological tests in order to evaluate anxiety and depression, in particular, the STAI (State-Trait Anxiety Inventory), the SDS (Self-rating Depression Scale), and 16 cartoon-like images representing stereotypes of menopause. The answers of our subjects showed high individual variation, with negative symptoms (e.g., hot flashes, memory loss) frequently associated with positive experiences (e.g., new hobbies, new life-styles). However, even the most frequent negative symptom (memory loss) was reported only by 70%. The experience of a change represented by menopause was described both in terms of objective change (e.g., weight increase, hot flashes, memory loss), and of subjective change (e.g., character, feeling of not being attractive, new life-styles). Treatment with HRT seems to reduce the onset of hot flashes considerably. The occurrence of anxious-depressive states was comparable to that observed in other studies; it was not associated with HRT, but rather to losses (loss of desire, memory loss, insomnia). In conclusion, menopause represents a transitional moment in which physical and psychological changes are generally integrated by the persons experiencing them. In order to preserve a good quality of life in menopause, it seems relevant to check memory loss and stabilize the mood in persons who are most "at risk" of psychological disease.

Coping with serum screening for Down syndrome when the results is given as a numeric value

Forty-six pregnant women undergoing second-trimester biochemical screening for Down syndrome were asked to fill in the State-Trait Anxiety Inventory (STAI) questionnaire to assess their anxiety level at two different moments: when recruited to the study (at 11-13 weeks' gestation), and after the test result was communicated. The test result was given as a numeric value of risk (1/x), rather than as positive/negative. There were 10 women in whom the risk after biochemical screening increased (median delta risk = +1/535, range = 1/69 to 1/1083), whereas in the remainder the risk decreased (median delta risk = -1/1576; range = -1/142 to -1/4947) compared with the baseline value calculated on maternal age alone. Although only in a minority of women the STAI score after biochemical screening exceeded the reference range, the change in the STAI score was significantly higher when the risk increased, and the change in the risk estimate correlated significantly with the change in this index of anxiety. Three out of seven women with a 'negative' test, but increased risk estimate and increased anxiety after biochemical screening chose to undergo amniocentesis. A policy of providing the result of biochemical screening for Down syndrome as a numeric value, even for 'negative' tests, may cause some women to experience anxiety and request amniocentesis.

Comparison of ciprofloxacin, ofloxacin and pefloxacin for the prevention of the bacterial infection in neutropenic patients with haematological malignancies

The efficacy of oral prophylaxis with ciprofloxacin, ofloxacin or pefloxacin was assessed in preventing bacterial infection in neutropenic patients with treatment being allocated randomly before beginning chemotherapy. Bacteraemia developed in six of 78 episodes (8%) treated with ciprofloxacin, in eight of 80 (10%) allocated to ofloxacin and in 12 of 77 (16%) when pefloxacin was given. However, there were no episodes involving Gram-negative bacilli among those given ciprofloxacin whereas three and seven episodes occurred in patients given ofloxacin or pefloxacin respectively (P = 0.013). With the exception of Pseudomonas aeruginosa, all potential pathogens isolated were resistant to all three fluoroquinolones. Faecal anaerobes were not affected by treatment with pefloxacin whereas their total numbers were reduced in 12 cases who had received ofloxacin and in nine cases who had been given ciprofloxacin (P = 0.002). Fourteen patients (18%) were colonized with pefloxacin resistant P. aeruginosa at the end of treatment with this agent compared with only two and five of those given ciprofloxacin or ofloxacin respectively. A similar trend was seen with other resistant Gram-negative bacilli colonizing 14%, 20% and 23% of patients for ciprofloxacin, ofloxacin and pefloxacin, respectively. Ciprofloxacin was therefore superior to the other two fluoroquinolones in preventing infections due to Gram-negative bacteria in this population of neutropenic patients.

Osteomyelitis and intervertebral discitis caused by Blastoschizomyces capitatus in a patient with acute leukemia

We describe the first known case of vertebral osteomyelitis and discitis caused by Blastoschizomyces capitatus in a leukemic patient and the results of therapy. We also reconfirm the microbiological characteristics which differentiate this species from other yeastlike pathogens.

Rapid diagnosis of bacterial contamination of blood: comparison of three automated microbial detection systems

Rapid methods of determining microbial contamination are needed in suspecting contaminated banked blood or other blood products. In this study, we experimented contaminated blood units with 122 strains of bacteria and fungi. After innoculation, a comparison between ESP Blood Culture System (Difco Laboratories Inc., Detroit MI), BacT/Alert (Organon Teknica, Durham, NC) and Bactec 9240 System was made for their efficiency in the detection of microbial contamination. Experimental data showed a diagnostic relevance of these automated systems with no significant differences in time detection of microbial contamination between the three methods under comparison.

Hepatosplenic infection caused by Candida parapsilosis in patients with acute leukemia

Candida parapsilosis is an exceptional agent in hepatosplenic candidosis. Here we report two cases of hepatosplenic infection caused by Candida parapsilosis in two patients with acute leukaemia. Open liver-spleen biopsy and previously minimal exposure to systemic antifungal drugs led to a cultural diagnosis in both patients. This report confirms the importance of an early diagnosis of these diseases in order to undertake appropriate therapeutic regimens.

Occurrence of bacteremia in hematologic patients

In the present study we reviewed eighty-six episodes of bacteremia occurred in 60 neutropenic patients and thirty-one episodes occurred in 30 non-neutropenic patients. Twenty-four out of 60 neutropenic patients suffered from multiple episodes of bacteremia, while only one out of 30 non-neutropenic patients presented multiple episodes. In neutropenic patients, 29 episodes of bacteremia were polymicrobial, whereas only one non-neutropenic patient had polymicrobial bacteremia. Intravascular catheters were the most common source of bacteremia (23.2%) in neutropenic patients, as compared with infections of the genito-urinary tract (45.1%) among non-neutropenic patients. In both groups, aerobic gram-positive cocci were the microorganisms most frequently isolated (71.6%). Anaerobic microorganisms showed an higher incidence in polymicrobial episodes than in monomicrobial episodes x 2 = 5.39 p = 0.02 OR = 2.97 95% CI (1.2-7.7).

Meningitis due to penicillin-resistant Streptococcus pneumoniae in patients with chronic graft-versus-host disease

Two episodes of meningitis due to penicillin-resistant Streptococcus pneumoniae occurring in two patients with chronic graft-versus-host disease (GVHD) are reported. Both patients were treated with ceftazidime. The first patient died, unresponsive to therapy. The second patient showed clinical improvement, reverting to her baseline mental status. This report draws attention to the fact that in chronic GVHD patients: (1) bacterial prophylaxis does not ensure protection against encapsulated bacteria; (2) rapid microbiological investigation is recommended with any upper respiratory tract infections.

Randomized comparison of ceftriaxone versus ceftriaxone plus amikacin for the empirical treatment of infections in patients with altered host defense: microbiological and clinical evaluation

Two hundred and eighty-four febrile episodes in immunocompromised patients were treated with ceftriaxone alone or in combination with amikacin. In the ceftriaxone-treated group, 60 out of 143 febrile episodes were microbiologically documented, while in the group receiving the combination therapy, there were 32 out of 140 (p = 0.0007). Gram-positive microorganisms were more common than gram-negative ones, accounting for 59 of the 101 isolated bacteria. The ceftriaxone regimen appeared to have a response rate comparable to the combination regimen (73.91 vs. 78.88%). Superinfections occurred under both regimens.

Evolution of the bandwidth of the principal states of polarization in single-mode fibers

The bandwidth in which the first-order approximation of the principal states of polarization of a single-mode fiber can be assumed valid is examined. The principal states of polarization and their bandwidth are found for a fiber with both constant coupling and birefringence, and the relationship with the fiber's eigenmodes is examined. On the basis of these results, a fiber cascade is analyzed, and a Monte Carlo simulation provides theoretical values of the bandwidth that have been experimentally verified on a 2-km-long concatenation of single-mode dispersion-shifted fibers.

Detection of bacterial contamination in bone marrow graft

A rapid method of determining bacterial contamination was used in a series of fifty-five bone marrow harvests (20 allogeneic and 35 autologous transplantations). The microbiological culture assays executed on bone marrow samples soon after the harvest and before the manipulation, showed a positivity only in the autologous bone marrow group. Another positivity was revealed after the freezing process of bone marrows for autologous transplantation. Two samples in the bone marrow group submitted to purging were positive after treatment and freezing process. In this study, the increase of bacterial contamination frequency seemed to be related to extensive handlings, such as pharmacological in vitro purging and freezing procedures.

Lipid peroxidation and lung ultrastructural changes in an experimental model of leukocyte-mediated pulmonary injury

The aim of this study was to study ultrastructural changes and lipid peroxidation in rabbits lung after massive complement activation and leukocyte aggregation. A prolonged and massive leukocyte activation was induced by intraperitoneal inoculation of zymosan suspected in paraffin. Fifteen animals (group 3) were given 0.6 g/kg of zymosan, 22 animals (group 2) received 1 g/kg, and 11 rabbits (group 1) were treated with paraffin alone and served as controls. An acute mortality rate of 40% was observed in group 3 and of 68% in group 2. Surviving animals were studied for 10 days. In these animals a marked decrease in circulating granulocytes and a progressive decline in arterial PO2 were recorded (PO2 on day 10 in group 2 animals was 51.94 +/- 4.26, p less than 0.01). Microscopic and ultrastructural evaluation revealed sequestration of granulocytes in the pulmonary microvasculature. Studies of lung homogenates demonstrated increased levels of lipid peroxide derivative malondialdehyde (group 2 rabbits, 1624 +/- 638; group 1, 795 +/- 57 pm/mg pt, p less than .001) and decreased levels of the tissue antioxidant alpha-tocopherol. The results of this study are compatible with the hypothesis of leukocyte-mediated injury through production of oxygen radicals.

Infection after autologous blood-derived stem cell transplantation

Ten patients who underwent autologous blood-derived stem cell transplantation (APBSCT) were studied retrospectively to determine the frequency and outcome of transplant associated infections during the hemopoietic reconstitution. Six patients developed an infection after transplant. Severe bacterial infections were unfrequent and mostly caused by gram-positive cocci. In no case pneumonia was observed and this scarce morbility of infection could be the result of early engraftment. None of them died for infection. The frequency of infections in APBSCT patients appears lower than the one observed in autologous bone marrow transplant patients.

Evaluation of azlocillin-amikacin combination for empirical therapy of infection in febrile neutropenic patients

We have evaluated the azlocillin-amikacin combination, given at a daily dose of 200 mg/kg and 15 mg/kg respectively, in the treatment of 62 consecutive febrile granulocytopenic patients (less than 500 PMN/microliters) affected by hematological disease. The effectiveness of the treatment was assessed in 60 patients, 44 (73%) of whom responded within 96 hours from the beginning. 36 of the responders showed microbiological and clinical infections, 2 had clinically documented pneumonia and 6 a possible infection. No improvement was obtained in 16 patients; 7 of whom suffered from clinical and microbiological infection, 2 from pulmonary mycosis, 4 from possible infection and 3 from doubtful infection. Seven of these patients subsequently responded to a proven antibiotic treatment, while only one of the remaining responded to a second-line empirical antibiotic schedule. These results suggest that the combination of azlocillin-amikacin was able to overcome about two-thirds of the infections, representing an effective remedy for the empiric treatment of febrile neutropenic patients.

In vitro susceptibility to quinolones and other antimicrobial agents of Staphylococcus species isolated from immunocompromised patients

A total of 237 Staphylococcus strains were isolated from different kinds of body tissues and fluids from immunocompromised patients admitted to the Hematology Department of Pescara Hospital (Italy). These strains, collected from November 1987 to September 1988, were studied for their susceptibility to methicillin and other drugs commonly used in therapy, and the minimum inhibitory and minimum bactericidal concentrations of five quinolones were determined. The killing curve of ciprofloxacin compared with nalidixic acid was determined. The results show a considerable activity of fluoroquinolones against all strains studied.

[Diffusion of smoking among high school students at U.S.L. No. 18 of the Tuscan region]

Between young people: 51% of male have never smoked, and only 38% of the females. If increase the age, increase also the percentage of whom that have had first meeting with cigarette smoke. Begin previously boys and they smoke more strongly. Today young people begin to smoke always more precociously, even if they are more informed.

Early diagnosis of adult respiratory distress syndrome: an experimental model of complement-mediated pulmonary injury

This article presents an experimental model of pulmonary injury resembling subclinical human adult respiratory distress syndrome (ARDS) mediated by leukocytes. The activation of complement was prolonged by an intraperitoneal injection of a suspension of zymosan in paraffin. The first step in the development of the disease was an accumulation of polymorphonuclear leukocytes in the lungs. No significant changes were observed on chest radiographs or computed tomograms and the pathophysiologic changes were only minimal in spite of the characteristic structural changes. The criteria currently used for the diagnosis of ARDS are not sensitive enough to detect the subclinical phase of the disease.

Cytogenetics and bone marrow transplantation

The authors report hematologic and cytogenetic data on 19 patients treated with allogeneic bone marrow transplantation (BMT) for severe hematologic disorders: 8 patients with chronic myelogenous leukemia, 6 with acute leukemia, 3 with severe aplastic anemia, 1 with refractory anemia, and 1 with beta-thalassemia major. Cytogenetic assays were performed on marrow cells before conditioning, 30 days after BMT, and at subsequent times. The authors discuss the role of cytogenetic studies in the evaluation of bone marrow engraftment, leukemic transformation of the graft, and disease relapse.