Prevention of antibiotic-associated diarrhea with Lactobacillus sporogens and fructo-oligosaccharides in children. A multicentric double-blind vs placebo study

AIM: The aim of this paper is to determine the efficacy of a fructo-oligosaccharides (FOS)-Lactobacillus sporogenes preparation in the prevention of diarrhea due to antibiotics in childhood. METHODS: A multicentre, randomised, double-blind versus placebo study was carried out. A total of 120 children, with active infections requiring antibiotics, were enrolled in the study and treated for 10 days either in the experimental group (F) or in the placebo one (P). The results of the study were recorded from the patients' diary and from follow-up clinical examinations. RESULTS: Out of 98 evaluable patients, 71% in group F had no diarrhea versus 38% in group P. The duration of diarrhea in F and P groups was 0.7 vs 1.6 days (p=0.002), respectively. CONCLUSION: Prophylaxis with Lactobacillus sporogens, associated to FOS, significantly reduced the number of days and duration of events in children with antibiotic-induced diarrhea.     

Prolylhydroxylase and procollagen type III in long-term survivors of acute lymphoblastic leukemia (ALL): a biochemical approach to HCV-related liver disease

BACKGROUND: We examined two proteins, prolylhydroxylase (hPH) and procollagen type III (PIIIP), as possible non-invasive HCV-related markers of liver disease. The purpose of this study was to assess whether the measurement of these proteins could serve to monitor HCV related liver damage in acute lymphoblastic leukaemia (ALL) patients. PROCEDURE: A total of 34 ALL patients, 24 HCV-seropositive and 10 HCV-seronegative, who had had increased transaminase values (ALT) for almost 6 months were studied. Serum hPH concentrations were determined by an immuno-enzymatic assay kit. PIIIP was assayed by the radioimmunoassay method. RESULTS: Both hPH and PIIIP were increased in ALL patients with chronic hepatitis C. Serum hPH levels were significantly elevated in those with chronic hepatitis C with either normal or high transaminases when compared to those who never were HCV seropositive. The sensitivity and specificity of these protein measurements to evaluate hepatic fibrosis were not supported by histologic confirmation because only 6 out of 12 patients with chronic hepatitis had a liver biopsy. CONCLUSIONS: Our study suggests that PIIIP and hPH values are significantly higher in ALL patients with chronic HCV with either normal or high transaminases. This might suggest that the liver damage is more marked in patients with chronic hepatitis and that the liver damage is related to the HCV rather than chemotherapy. Future studies correlating histologic findings with the serum biochemical markers are required to establish the sensitivity and specificity of hPH and PIIIP in predicting hepatic fibrosis and to confirm this association.     

Reduced folate carrier and dihydrofolate reductase expression in acute lymphocytic leukemia may predict outcome: a Children's Cancer Group Study

PURPOSE: Methotrexate is a major component of current treatment regimens for children with acute lymphocytic leukemia (ALL). Potential mechanisms of methotrexate resistance include impaired drug uptake, decreased drug retention, and dihydrofolate reductase (DHFR) amplification. The purpose of this study was to assess whether reduced folate carrier (RFC) and DHFR expression in untreated leukemic blasts correlated with outcome. METHODS: Quantitative real-time RT-PCR was used to measure RFC and DHFR mRNA expression in leukemic blasts from 40 newly diagnosed patients with ALL obtained in a blinded fashion from Children's Cancer Group studies. RESULTS: Low RFC expression at diagnosis correlated significantly with an unfavorable event free survival. Surprisingly, low, not high, DHFR expression correlated significantly with an unfavorable event-free survival. Proliferative cell nuclear antigen (PCNA) expression demonstrated a weak inverse relationship between sample PCNA and DHFR or RFC expression, suggesting that DHFR and RFC expression may be markers for factors other than drug resistance. CONCLUSIONS: These results suggest that impaired transport may be an important mechanism of intrinsic methotrexate resistance in ALL, and DHFR expression also may be an important prognostic factor in ALL. Additional studies are necessary to clarify the mechanism for the correlation of low DHFR expression with poor outcome.     

Description of chagas disease in the Valle de Iguala, Guerrero state, Mexico- Marco

There are reports regarding the presence of triatomine vectors of Trypanosoma cruzi, the causal agent of Chagas' disease, and infected individuals on the coast and zones south of the State of Guerrero, Mexico. Nonetheless, there are no completed reports in the Valley of Iguala. To know with greater precision endemic zones, seropositive individuals and their health condition, T. cruzi-infected triatomines and characteristics of dwellings were studied. Seroprevalence was 1.8% by indirect ELISA and latex agglutination techniques were carried out in serum of 450 individuals of three municipalities of the Valley of Iguala. We reported presence of triatomine and conditions of dwellings. Of 71 triatomines collected, 38.2% were infected with T. cruzi. Triatoma pallidipennis was the only triatomine species found. No seropositive persons presented intestinal, or cardiac problems. The greatest percentage of infected triatomines was observed in rural zones as compared to urban. Results suggest considerable risk of infection in the Valley of Iguala but studies regarding the infectivity capacity of T. cruzi strains are required.     

Low-birth-weight neonates exhibit a physiological set-point to regulate CO2: an untapped potential to minimize volutrauma-associated lung injury

The objective of this article is to determine whether low-birth-weight (LBW) infants have the capacity to modulate minute ventilation to achieve a CO (2) set-point within ranges acceptable to clinicians during a procedure designed to identify the best dynamic compliance loops. By using dynamic flow-loop mechanics, we performed a prospective stepwise reduction of tidal volume (by reduction of peak inspiratory pressure, keeping end-expiratory pressure constant), in a group of LBW infants to identify the steepest slope of the dynamic flow-loop. We used flow-synchronized, assist-control mechanical ventilation with termination sensitivity set at 5%. Vital signs and blood gases were assessed every 15 minutes at each stepped-pressure change during the first hour after enrollment and after 12 hours, to evaluate oxygenation and ventilation. Peak inspiratory pressure (PIP) was selected at the lowest level that achieved target range blood gases. The acute reduction of PIP and the resulting lower tidal volume was initially associated with an increase in the spontaneous respiratory rate in the first hour that also was associated with a significant decrease in patient-selected inspiration time. After 12 hours, the spontaneous respiratory rate returned to baseline; the peak PaCO(2) was 43.8 +/- 2.03 (mean +/- SEM). LBW infants have the capacity to alter respiratory rate to change minute ventilation in response to a reduction of tidal volume created by lowering the PIP. Using this model of endogenous CO(2) challenge in ventilated infants, we conclude that LBW neonates have the capacity to select a CO(2) set-point. This approach suggests an important avenue through which a clinician can minimize volutrauma through a reduction of PIP and use of expiratory trigger to limit excessive PIP and an overall lower mean airway pressure.     

Preliminary report on a new and noninvasive method for the assessment of fetal lung maturity

OBJECT: Several patterns of fetal breathing movements (FBMs), i.e. abdominal wall movements (AWm), thoracic wall movements (TWm) and nasal fluid flow velocity waveforms (NFFVW), were investigated by ultrasound (US) technology and related to fetal pulmonary maturity and immaturity, i.e. fetal lung maturity (FLM) tests, in order to validate the hypothesis that they may indicate whether the fetal lung is mature or immature, regardless of gender, weight and gestational age. MATERIAL AND METHODS: We prospectively enrolled 143 high-risk pregnancies in which a complete US study of FBMs and FLM tests was performed. Among them 43 women satisfied the inclusion criteria. US-FLM was defined as the presence of regular NFFVW detected by pulsed Doppler and spectral analysis, or irregular NF-FVW synchronous with TWm detected by M-mode. An US guided amniocentesis was performed in order to collect amniotic fluid (AF) and FLM was evaluated by L/S (lecithin/sphingomyelin) determination, presence of phosphatidylglycerol (PG) and lamellar bodies (LBs) count. At the end of the study the diagnostic accuracy of US-FLM was compared to that of FLM tests. RESULTS: Diagnostic accuracy for US evaluation of FLM was as follows: sensitivity: 89.6%; specificity: 85.7%; PPV: 92.8%; NPV: 80%. Diagnostic accuracy of FLM tests was as follows: sensitivity: 100%; specificity: 51.7%; PPV: 100%; NPV: 50%. L/S determination predicted lung maturity with a sensitivity of 100%; specificity of 93.1%; PPV of 100%; NPV of 87.5%. CONCLUSION: Presence of regular NFFVW or irregular NFFVW and TWm correlate accurately with conventional FLM tests. We suggest that this noninvasive procedure may be helpful for assessing FLM, particularly under certain circumstances, e.g., oligo-anhydramnios, laboratory logistic equipment difficulties or heavily stained AF samples, amniocentesis refusal, religious concerns.     

Diet and risk of seromucinous benign ovarian cysts

Objective: To analyze the relation between selected dietary indicators and the risk of seromucinous benign ovarian cysts. Study design: We used data from a case–control study on risk factors for benign ovarian cysts conducted in Italy between 1984 and 1994. Cases included 225 women with a histologically confirmed diagnosis of benign seromucinous ovarian neoplasm dating back no more than 2 years. Controls were 450 women below the age of 65 years admitted for acute non-gynecological, non-hormonal, non-neoplastic conditions. Results: Women with seromucinous cysts reported more frequent consumption of beef and other red meat and cheese and less frequent consumption of green vegetables. The multivariate odds ratios (ORs) in highest versus less frequent consumption levels were 2.7 (95% confidence interval (CI) 1.8–4.3) for beef and other red meat, 0.6 (95% CI 0.3–0.9) for green vegetables and 1.4 (95% CI 1.0–2.2) for cheese. Conclusion: Seromucinous benign ovarian cysts are associated with beef and cheese consumption, whereas high intake of green vegetables seems to have a protective effect.     

Expression and prognostic significance in epithelial ovarian cancer

BACKGROUND: Insulin-like growth factor binding protein-3 (IGFBP-3) is a glycoprotein with specific binding affinity to peptide hormones insulin-like growth factors (IGFs) which are potent mitogens for a variety of cells. IGFBP-3 can inhibit the activities of IGFs by interfering with the interaction between IGFs and their receptor IGF-IR. Epithelial ovarian cancer (EOC) tissues express IGFBP-3, IGFs and IGF-IR. Moreover, high levels of IGF-I and IGF-IR have been shown in epithelial ovarian cancer, and IGF-I stimulates the growth of ovarian cancer. METHODS: We measured IGFBP-3 levels in ovarian cancer tissues of 147 consecutive patients and we examined its association with clinical and pathological features of the disease and patient survival. The average age of the patients in the study was 55 years and the median follow-up time was 37 months. IGFBP-3 levels were measured in the tissue extracts by a commercial ELISA kit and non-parametric statistics and the Cox regression survival analysis were used to determine the associations of IGFBP-3 with clinical and pathologic variables as well as with patient survival. RESULTS: High IGFBP-3 levels resulted significantly associated with some of the favorable prognostic features of the disease, including early clinical stage (p=0.048), small size of residual tumor (p=0.007), and optimal debulking result (p=0.007). High IGFBP-3 was also associated with a significantly reduced risk for disease progression (RR=0.52, p=0.034) and we showed an inverse dose-dependent relationship between IGFBP-3 and disease progression-free survival (p=0.033). However, the association with disease progression-free survival was no longer statistically significant in a multivariate analysis. An association between IGFBP-3 and overall survival was not shown. CONCLUSIONS: This study suggest that IGFBP-3 may play a role in the progression of epithelial ovarian cancer.