Preventive measures suggested to protect health workers from the risk due to a potential exposure to SARS agents

The Authors describe the personal and environmental preventive measures suggested to protect health workers from the risks due to a potential exposure to SARS agents. The Authors stress the need that workers are allowed to wear individual protective disposable complying with technical regulations in order to be assured the best protection.     

Efficacy of levetiracetam in Huntington disease

OBJECTIVE: Levetiracetam (LEV) is a novel antiepileptic drug characterized by a wide spectrum of action; no pharmacologic interaction and poor adverse events are reported. In animal models, effects of LEV are observed in basal ganglia. The aim of this study was to evaluate the efficacy of LEV in reducing involuntary movements in subjects affected by Huntington disease (HD). METHODS: This was a single-center, short-term, open-label, controlled study. Patients had LEV as add-on therapy for 6 months. In the first visit patients were rated according to the Unified Huntington Disease Rating Scale. Every 2 months they were submitted to all these tests. LEV was added at the dose of 500 mg twice daily for the first 2 months and then the dosage was increased until 1000 mg twice daily for the next 4 more months. The authors enrolled 22 patients: 15 were assigned to the LEV group and 7 were enrolled as control subjects. RESULTS: No serious adverse events were experienced by the treated patients. After 6 months of treatment patients on LEV showed a significant reduction of involuntary movements, with a slight improvement of functional capacity compared with the control group. CONCLUSION: Results of this short-term, prospective, controlled study indicates that in HD patients, LEV is effective in reducing involuntary movements, thus improving the quality of life.     

Diphtheria antitoxin levels in the 14–30–year age group in Italy

In order to verify diphtheria immunity a seroepidemiological survey was performed in 1996–1997. Serum samples were obtained from 501 subjects 14 years old, recruited at 8 schools in Rome, and from 490 subjects 20–30 years old recruited from 15 Italian regions. Serum diphtheria antitoxin was titrated using the Vero cell assay. The minimum protection level of antitoxin was set at 0.01 IU ml^-1. The results show that the younger population have a good immunity to diphtheria while a large proportion of young adults is devoid of protective levels of diphtheria antitoxin. Out of the 501 subjects 14 years old, 495 (98.8%) had a diphtheria antitoxin titre 0.01 IU ml^-1. Only 6 (1.2%) teenagers were susceptible. Out of the 490 subjects 20–30 years old, 109 (22.2%) were susceptible, 381 (77.8%) had a diphtheria antitoxin titre 0.01 IU ml^-1. The data stress for booster immunization at the end of junior high school.     

Amyloid in bone marrow smears of patients affected by multiple myeloma

Systemic AL amyloidosis is associated with nearly 15% of cases of multiple myeloma, but data on the frequency and significance of amyloid deposits in the bone marrow of patients affected by multiple myeloma without clinical signs of systemic amyloidosis are scanty. Bone marrow smears of 166 unselected patients affected by multiple myeloma (126 at diagnosis and 40 after treatment) were stained with Congo red and studied by transmission and birefringence microscopy. Both focal and diffuse storages were considered positive. Overall, 67 patients were positive and 99 were negative to Congo red and apple-green birefringence. In particular, 51 of the 126 patients studied at diagnosis and 16 of the 40 patients with advanced disease were positive. Seventeen patients were reassessed after a mean follow-up of 32 months (range: 6–91): disappearance of amyloid deposits was verified in three cases, all responsive to bortezomib-based regimens. The preliminary data available suggest that amyloid deposition in the marrow of myeloma patients is frequent, as it can be traced in nearly 40% of cases. We failed to find correlations between bone marrow amyloid deposits and immunoglobulin type, disease stage, plasma cells percentage, hemoglobin, calcium, creatinine, albumin, or β₂microglobulin. Significantly higher incidence of moderate/severe peripheral neuropathy was found in patients with marrow amyloid exposed to potentially neurotoxic antineoplastic agents. Further studies and prolonged follow-up are needed to validate our findings and to define possible prognostic aspects.     

Sestamibi and FDG-PET scans to support diagnosis of jaw osteonecrosis

Osteonecrosis of the maxillary or mandibular bone is an infrequent but often severe event occurring in patients who undergo prolonged treatment with bisphosphonates. Histology is in some cases mandatory to differentiate it from neoplastic osteolysis, but a biopsy can further contribute to bone damage. Functional imaging obtained by a tracer that shows oncotropic properties, such as Tc99m-sestamibi, in comparison to a non-tumor-specific substance such as FDG-PET, can support the differential diagnosis, thus avoiding invasive procedures. Four patients affected by multiple myeloma and jaw osteonecrosis were prospectively evaluated by sestamibi and FDG-PET scans. Local diagnosis was performed by clinical, radiological and, in some cases, histological evaluations. Each patient was studied by Tc99m-sestamibi, performed by planar anterior and posterior whole-body scans and SPECT of the head and neck, and by PET/CT. Two nuclear medicine physicians, unaware of the final diagnosis, reviewed the images. No sestamibi uptake was evident in the four patients with jaw osteonecrosis, while FDG-PET/CT showed focal uptake in all of them. Our study suggests that the combined use of sestamibi scintigraphy and FDG-PET/CT could support the clinical diagnosis of oral osteonecrosis avoiding the risks of a surgical biopsy. Studies on higher number of patients are necessary to validate these preliminary observations.     

Attitudes and behavior of health care personnel regarding influenza vaccination

This paper reports the results of a study conducted by the Italian Association for Immuneprophylaxis promotion (AIPI) with the aim of surveying the attitudes and perceptions of Italian health care workers regarding the use and efficacy of influenza vaccine. The results clearly show that a high proportion of the questioned health care workers showed a general lack of concern about the severity of the disease. Doubts about vaccine efficacy and fear of post-vaccination side effects were also observed to have an important influence on the vaccination acceptance rates. These data underline the need for a systematic education program to provide influenza vaccination within the public and private health-care sectors in Italy.