Kawasaki disease and cardiac involvement: an update on the state of the art

Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. It has a self-limiting course and so far, represents the most common cause of coronary heart disease acquired in children aged between 6 months and 5 years. The inflammatory process can involve the coronary arteries with the formation of aneurysms and thrombotic occlusions with the risk of sudden death, especially in infants. Myocardial inflammation and abnormalities of cardiac contractility can occur acutely or many years after the disease onset. Therapy must be started within 10 days after the onset of symptoms to reduce the risk of heart complications. Immunoglobulin and aspirin treatment are effective in reducing heart complications. Recent studies have shown new therapeutic strategies (corticosteroids, immunosuppressive and biological drugs) in case of ineffectiveness of treatment with immunoglobulins.

Hypertension in childhood

Hypertension is a growing health problem in children, and it is an important parameter of cardiovascular risk for adults. It is classified as primary (influenced by obesity, sedentary lifestyles and poor-quality food) or secondary to underlying causes. The AAP 2017 guidelines recommend measuring blood pressure every year from the age of three and in children under the age of three only if they have known risk factors. The measurement of infantile hypertension is relatively complicated and instable and, for this reason, ambulatory blood pressure monitoring (ABPM) and multiple office BP measurement (mOBPM), especially in infants who are not collaborating are indicated. High blood pressure may have an adverse effect on the heart, the vessels, the kidney, and the central nervous system so it is important recognize it and act promptly. Hypertension is initially treated with lifestyle changes such as weight loss, a healthy diet, and regular exercise, but, if non-pharmacological interventions have failed, a pharmacological treatment with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, thiazide diuretics and/or beta blocker may be indicated.

Impact of influenza during the post-pandemic season: epidemiological picture from syndromic and virological surveillance

INTRODUCTION

Following the observation that 1 or 2 pandemic peak due to the circulation ofAHINlv had occurred in most countries and in most World Health Organization (WHO) Regions, WHO declared on August 10"h, 2010 that the world was moving into the post-pandemic period, whose surveillance presents considerable interest both from epidemiological and clinical point of view. We described the epidemiological picture emerged from syndromic and virological surveillance during the post-pandemic season in Liguria, Italy.

MATERIALS AND METHODS

An Emergency Department Syndrome surveillance system, based on data collected at "San Martino" and IRCCS "G. Gaslini" Liguria Regional Reference University Hospitals for adults and children is active since July 2007. Monitored syndromes include "Influenza-Like Illness" (ILl) and "Low Respiratory Tract Infections" (LRTI). The Ligurian Regional Reference laboratory for Influenza virological surveillance and diagnosis offers rapid detection of influenza viruses by real-time and block RT-PCR, viral culture and genetic characterization by entire sequence analysis of haemagglutinin- and neuraminidase-coding regions in accordance with the international standards established by the global laboratory network.

RESULTS AND DISCUSSION

The integration of syndromic surveillance system and laboratory surveillance for rapid detection and characterization of the disease responsible agent represented a specific and sensitive tool for influenza surveillance. The post-pandemic season was characterized by early onset and by the heaviest impacts for ILI and LRTI among the recent epidemic seasons. In contrast to the picture observed during the pandemic season, the 2010/11 winter was characterized by the intensive circulation of pandemic AH1N1v coupled with sustained activity due to influenza B and Respiratory Syncytial Virus (RSV). Antigenic and molecular characterization of influenza strains confirmed the good matching between circulating and 2010/11 vaccine viruses.

Effect of calcitonin on ACTH secretion

We have investigated the effects of salmon calcitonin injected intracerebroventricularly on adrenocorticotropic (ACTH) secretion in rats. Salmon calcitonin was able to increase significantly (p less than 0.05) ACTH secretion at the dose of 5 ng/rat and (p less than 0.01) at the doses of 12.5, 25 and 50 ng/rat; the effect (50 ng/rat) was maximal at 30 min and still present after 60 and 120 min. The maximal dose of calcitonin produced a significant (p less than 0.05) increase in serum ACTH concentration also in stressed animals. It is suggested that calcitonin may increase serum ACTH secretion by central norepinephrine and/or 5-hydroxytryptamine pathways that regulate corticotropic releasing factor activity.

Glomerular lesions in experimental infections of Schistosoma mansoni in Cebus apella monkeys

Three monkeys (Cebus apella) experimentally infected with Schistosoma mansoni studied for periods of 19, 14, and 11 months showed deposits containing gamma-globulin in subendothelial and subepithelial basal membranes and in basement membranes proper. The glomeruli showed mild reactivity characterized by local hypertrophy and hyperplasia of mesangial cells. Such findings were close to those observed by us in the kidney of hepatosplenic schistosomiasis patients without evidence of renal disease. The distribution of the deposits, both in human and experimental disease, are suggestive of preformed, non-glomerular antigen-antibody complexes that form in a zone of excess antigen and become trapped in the glomerular capillaries.The possibility exists, but has not yet been proved beyond doubt, that renal disease in schistosomiasis patients could be the end result of this pathogenetic mechanism.