Epidemiology and biology of nematodofauna affecting Testudo hermanni, Testudo graeca and Testudo marginata in Italy

Tortoises of the genus Testudo living in Italy are Testudo hermanni, Testudo graeca and Testudo marginata. Although a great deal of information has been acquired on the internal medicine and surgery on these animals, little is known of their parasitological fauna. A survey on the presence of gastro-intestinal parasitic nematodes in tortoises bred in Italy was carried out to acquire extensive epidemiological data. Stool samples of 62 tortoises (37 T. hermanni hermanni, 13 T. graeca, 6 T. hermanni boettgeri and 6 T. marginata) were macroscopically examined and subjected to qualitative (flotation and Baermann techniques) and quantitative (McMaster technique) microscopic examinations. Adult nematodes were identified using morphological keys. Eggs of oxyurids (species indistinguishable) and adults of Alaeuris numidica, Mehdiella microstoma, Mehdiella uncinata, Tachygonetria longicollis, Tachygonetria conica and Tachygonetria palearcticus (Oxyurida, Pharyngodonidae); larvae and adults of Atractis dactyluris (Ascaridida, Atractidae); and eggs and adults of Angusticaecum holopterum (Ascaridida, Ascarididae) were identified in all animals >1 year, whereas all tortoises <1 year of age were parasite-free. Moreover, this study reports for the first time A. numidica and M. microstoma in T. marginata. This work shows that nematodes affecting tortoises are diffused in Italy and highlights the need to investigate their epidemiology more in depth.     

In vitro inhibitory effect of lercanidipine on cholesterol accumulation and matrix metalloproteinases secretion by macrophages

Plaque rupture and thromboembolism play a major role in atherosclerotic acute syndrome. Experimental studies have demonstrated the potential direct anti-atherosclerotic effects of calcium antagonists. We investigated the in vitro effect of lercanidipine (REC 15/2375), a third-generation, highly lipophilic calcium antagonist on cholesterol metabolism and matrix metalloproteinases secretion in macrophages, two functions that predispose plaques to rupture. Lercanidipine (10(-6)-10(-5) M) inhibited cholesterol esterification in macrophages and reduced cellular free and esterified cholesterol accumulation from acetylated LDL (63%, 62% of control P < 0.05, respectively). In addition, lercanidipine inhibited the release of metalloproteinases in the extracellular medium (50% and 95% inhibition at 10(-5) M for MMP-9 and MMP-2, respectively). Experiments performed with lercanidipine enantiomers or other dihydropyridine derivatives, endowed with different lipophilicity and affinity for calcium channels, indicated that the above effects could be related to the lipophilic, but not to the calcium channel blocking properties of these molecules. When cells, after exposure to the drug, were allowed to equilibrate, lercanidipine inhibitory action could be observed at initial concentrations as low as 10(-9) M, which is the actual concentration range observed in plasma in clinical settings. In conclusion, our data indicate that lercanidipine may exert potent anti-atherosclerotic effects by inhibiting macrophage functions involved in plaque stability.     

Hospitalization for pneumonia in adults. Lazio, 1997-1999

The aim of this study is to define the burden of pneumonia requiring hospitalization among adults in Lazio region from 1997 to 1999 and to describe the characteristic of community acquired (CAP), suspected nosocomial (NP) and in AIDS pneumonia. The data source is the hospital discharge register. 30517 incident episodes of pneumonia hospitalization occurred in the three years period, 20497 CAP, 9760 NP and 964 in AIDS of which 704 supposed to be acquired in hospital; the mean age is 65, 69 and 38 years respectively. Standardized hospitalization rates for CAP do not show a clear geographical pattern, while for NPs and in AIDS they are higher in the city of Rome than in the rest of the region. There are peaks of incidence during the winter for CAPs and NPs but not for AIDS. Only 20% of pneumonias have etiological diagnosis. The proportional analysis of aetiological agents shows: pneumococcus, pseudomonas, staphylococci and influenza; the most frequent comorbidities are: circulatory diseases, chronic obstructive pulmonary disease (COPD), malignancies and diabetes. 3.9% of individuals in the study with CAP or NP had more than one episode of pneumonia during the study period, for those with pneumonia in AIDS this percentage was 14.8. In-hospital lethality is 9.4%, 29.3% and 11.2% for CAP, NP and in AIDS, respectively. Data from the hospital discharge registers can be used to give a cheap and rapid glimpse to the epidemiology of pathologies frequently requiring hospitalisation neglected from more analytical surveillance systems or registries.     

Impact of guidelines in investigating foodborne disease outbreaks services in Lazio region, Italy

Epidemiological investigation of foodborne disease outbreaks helps us to better define the risks, hazards and vehicles involved. In 1997 guidelines on epidemiological methods for investigating these outbreaks were implemented in the Lazio Region. Methods used in investigating the 410 foodborne disease outbreaks reported in the 1996-2000 period were analysed to evaluate the impact of the guide lines on health services. Specific food attack-rates (epidemiological methods) were calculated more frequently in outbreaks with setting of mass catering with many exposed people (46% of these outbreaks) than in outbreaks in home setting with few exposed people (13% of these cases). Inversely, in smaller outbreaks the proportion of cases with detected aetiology (microbiological method) was higher (66%) than in larger ones (43%). For foodborne disease outbreaks with at least 30 people exposed epidemiological methods of investigating showed temporal trend in the period 1996-2000: the epidemics in which attack rates were calculated increased from 50% to 83%, those in which epidemic curve was drawn increased from 17% to 79%, and those in which food specific attack rates were calculated increased from 33% to 58%. The hazard analysis of critical control points (HACCP) was performed only in 18.3% of the cases. In conclusion, the guide lines resulted in a wider application of epidemiological methods in large outbreaks with a well defined exposure resulting in an improved detection of vehicles of foodborne diseases. Epidemiological methods possibly are not adequate to investigate smaller foodborne outbreaks.     

Peripheral artery disease in type 2 diabetes: the role of fibrinolysis

The aim of the present study is to verify the relationship between peripheral artery disease (PAD) and some coagulation/fibrinolysis parameters in type 2 diabetic patients. Sixty-three type 2 diabetic patients, without PAD, were studied at baseline and after 4 years. Assessments included tissue-Plasminogen Activator (t-PA), Plasminogen Activator Inhibitor-1 antigen (PAI-1 Ag), Plasminogen Activator Inhibitor-1 activity (PAI-1 Act), Plasminogen (Pl), Fibrin peptide A (FPA), Fibrinogen (Fr), and the ankle/brachial pressure index (ABI). We observed a significant difference between diabetic patients and controls as regards tPA (11.8 +/- 5.4 vs. 6.6 +/- 3.0 ng/ml; p <0.05) and PAI-1 Act (17.8 +/- 9.2 vs. 11.7 +/- 6.6 ng/dl; p <0.005). After 4 years 13 diabetic patients became vasculopathic and, at baseline, had significantly lower tPA (8.9 +/- 4.8 vs. 12.5 +/- 5.3; p <0.011), and higher PAI-1 Ag (50.8 +/- 22.2 vs. 32 +/- 22.2; p <0.006), and PAI-1 Act values (24.1 +/- 9.5 vs. 16.1 +/- 8.4; p <0.014), compared with 50 diabetic patients who did not develop PAD after 4 years. These data show that the physiological equilibrium which exists between t-PA and PAI-1 moves towards higher levels in our diabetic patients compared with controls, at baseline, whereas diabetic patients who developed PAD showed a shift towards an antifibrinolytic pathway with diminished t-PA, increased PAI-1 Ag and PAI-1 Act and consequently procoagulant activity. Our study suggests that hypofibrinolysis may be involved in the future onset of PAD in type 2 diabetic patients.     

Adrenal extramedullary hematopoiesis: Report on a pediatric case and update of the literature

The authors report on a rare pediatric case of adrenal extramedullary hematopoiesis in a patient with beta-thalassemia disease. The lesion was clinically discovered as incidentaloma of the right adrenal gland and treated by surgery. Adrenal extramedullary hematopoiesis may clinically be detected as incidentaloma. Adrenal incidentalomas presenting with hematologic disorders, such as agnogenic myeloid aplasia and beta-thalassemia, need careful imaging as well as adrenal hormonal investigation in order to exclude malignancy and sublinical hypersecretory syndromes. Ultrasound or CT-FNA of the lesion are effective in finding out the disease.     

Management of Tracheobronchial Amyloidosis With Therapeutic Bronchoscopic Techniques

Amyloidosis is a systemic disease caused by abnormal deposition of amyloid material that is detected with Congo red staining and is difficult to diagnose. Involvement of the tracheobronchial tree is rare and is a challenge for pulmonologists because of the wide differential diagnosis of this disease. We present two cases where tracheobronchial affectation has been observed: in one of them as a primary disease, and in another as secondary affectation. The use of bronchoscopic techniques is essential for the diagnosis of tracheobronchial involvement. In the absence of an effective drug therapy, local management of this disease with endoscopic techniques for bronchial repermeabilization is able to provide clinical improvement and expand the treatment options and prognosis in this disease.