Respiratory syndrome and respiratory tract infections in foreign-born and national travelers hospitalized with fever in Italy

BACKGROUND: We measured frequency and epidemiologic, clinical, and hematochemical variables associated with respiratory tract infections (RTIs) in foreign-born and national patients hospitalized with fever with a history of international travel, and compared the final diagnosis of RTI with the presence of a respiratory syndrome (RS) at presentation. METHODS: A prospective, multicenter, observational study was conducted at tertiary care hospitals in Northern Italy from September 1998 to December 2000. RESULTS: A final diagnosis of RTI was obtained in 40 cases (7.8%), 27 (67.5%) with lower RTI and 13 (32.5%) with upper RTI. The most common RTIs were pneumonia (35%) and pulmonary tuberculosis (15%). A white blood cell count > or = 10,000 and an erythrocyte sedimentation rate > or = 20 mm/h were independently associated with a final diagnosis of RTI; onset of symptoms at > or = 16 days and > or = 75% neutrophils were independently associated with lower RTI. An RS was identified in 51 (9.9%) of 515 travelers. Sensitivity, specificity, and positive and negative predictive values of a diagnosis of RS for a final diagnosis of RTI were 67.5%, 94.9%, 52.9%, and 97.2%, respectively. CONCLUSIONS: Pneumonia and pulmonary tuberculosis were frequent among foreign-born and national travelers with fever admitted to a tertiary care hospital. Half of the pneumonia cases did not present with an RS at first clinical examination.     

Simultaneous mutations in the CLCNKB and SLC12A3 genes in two siblings with phenotypic heterogeneity in classic Bartter syndrome

Two siblings (brother and sister) with renal tubular hypokalemic alkalosis underwent clinical, biochemical and molecular investigations. Although the biochemical findings were similar (including hypokalemia, metabolic alkalosis, hyperreninemia, hyperaldosteronism and normal blood pressure), the clinical findings were different: the boy, who also presented syndromic signs, developed glomerular proteinuria and renal biopsy revealed focal segmental glomerular sclerosis; the girl showed the typical signs of classic Bartter syndrome. As described in a previous paper, a heterozygous mutation (frameshift 2534delT) was demonstrated in the gene encoding the thiazide-sensitive NaCl co-transporter (SLC12A3) of the distal convoluted tubule; the second molecular analysis revealed a compound heterozygous mutation (A61D/V149E) in the CLCNKB chloride channel gene in both subjects, inherited in trans from the parents. The children were finally diagnosed as having classic Bartter syndrome. These cases represent the first report of the simultaneous presence of heterozygous and compound heterozygous mutations in the SLC12A3 and CLCNKB genes, both of which are involved in renal salt losing tubulopathies, and confirm previous observations regarding classic Bartter syndrome phenotype variability in the same kindred.     

Influence of maternal magnesium sulphate and ritodrine treatment on cerebral blood flow velocity of the preterm newborn

BACKGROUND: To evaluate the effect of antenatal tocolytic administration of magnesium sulphate and ritodrine on the cerebral blood flow velocity and on the cerebral vascular resistance of preterm newborns in the first hours of life. METHODS: Cerebral blood flow velocity, resistance index and relative vascular resistance were studied in 27 preterm infants (<34 weeks gestation) with antenatal exposure to maternal magnesium sulphate treatment and in 27 preterm infants (<34 weeks gestation) with antenatal exposure to maternal ritodrine treatment. Both antenatal magnesium sulphate or ritodrine were used for tocolysis. Cerebral blood flow was measured, using Doppler ultrasonography, in the anterior cerebral artery, in the left middle cerebral artery and in the right middle cerebral artery. RESULTS: We did not find any significant difference in the blood flow velocity, resistance index or relative vascular resistance in the three cerebral arteries between the two treatment groups. CONCLUSIONS: Our study shows that maternal antenatal administration of magnesium sulphate to delay preterm delivery, compared to antenatal administration of ritodrine, does not induce any significant differences either in cerebral blood flow velocity or in cerebral vascular resistance of preterm infants in the first hours of life.     

Occupational asthma due to metoclopramide hydrochloride (MCPH)

Metoclopramide hydrochloride (MCPH) is dopamine antagonist antiemetic drug that binds D2 receptor at the central nervous system and peripheral levels, which stimulates the upper gastrointestinal tract motility. It is often used in the management of some forms of nausea and vomiting (1-3). Occupational allergy to drugs is seldom reported. No case of occupational allergy to MCPH have been reported, to date. We present a case of airborne allergic asthma in a worker employed in the synthesis of Metoclopramide hydrochloride.     

Endocrinological study of the dopaminergic regulation of prolactin release in metastatic breast cancer

AIMS AND BACKGROUND: Prolactin (PRL) may be a growth factor for breast cancer. Abnormally high levels of PRL have been proven to be associated with a poor prognosis in metastatic breast cancer. However, most studies have been limited to the evaluation of basal levels of PRL rather than its response to the classical endocrine dynamic tests. This study was performed to analyse the dynamic secretion of PRL under stimulatory and inhibitory tests in metastatic breast cancer. METHODS: The study included 10 untreated metastatic breast cancer women, who were evaluated after the classical stimulatory and inhibitory tests for PRL secretion with the antidopaminergic agent Metoclopramide (10 mg iv as a bolus) and with L-dopa, respectively. Serum levels of PRL were measured by RIA before and at subsequent intervals after drug administration. PRL levels were considered to be elevated when they were higher than 25 ng/ml. RESULTS: Abnormally high basal levels of PRL were seen in 6/10 patients. L-dopa was unable to inhibit PRL secretion, whose mean concentrations paradoxically significantly increased in response to L-dopa, with values comparable to those observed after the classical stimulatory test with metoclopramide. CONCLUSIONS: This study confirm the existence of hyperprolactinemia associated with metastatic breast cancer. In addition, by showing a paradoxical rise of PRL in response to L-dopa, which inhibits PRL secretion in physiological conditions, this study would suggest that breast cancer-related hyperprolactinemia may depend at least in part on endogenous disease-related neuroendocrine alterations.     

Validity and reproducibility of an interviewer-administered food frequency questionnaire in Austrian adults at risk of or with overt diabetes mellitus

Food frequency questionnaires (FFQs) provide an inexpensive tool for dietary assessment. Given the scarcity of data on their validity for nutritional analysis in persons with overt diabetes mellitus or with increased risk of diabetes (relatives of patients with diabetes), this study tests the hypothesis that an FFQ, adapted to local dietary habits, yields a reliable estimate of nutrient intake when compared with 7-day food record (7DR) in healthy, prediabetes, and diabetes cohorts. One hundred three volunteers (50 persons with overt diabetes mellitus, 24 relatives of patients with diabetes, and 29 nondiabetic individuals without a family history of diabetes) completed both FFQ and 7DR. A second FFQ was completed by 100 of these volunteers after 3 months to evaluate its reproducibility. Data were compared by correlation and Bland-Altman analyses. Across the entire group, estimates for gram intakes of nutrients and total energy were associated with wide limits of agreement between FFQ and 7DR (correlation coefficients, 0.23-0.72; P < .02). Compared with 7DR, the FFQ overestimated intakes of saturated fat in the entire group (+6.6 ± 14 g; P < .001) and in persons with overt diabetes mellitus (+7.6 ± 15 g; P < .001) but underestimated protein intake in relatives of patients with diabetes (−16.36 ± 31 g; P = .01). The repeated FFQ revealed variable agreement (correlation coefficients, 0.34-0.72; P < .001) and underestimated (P < .01) macronutrient and total energy intakes, with slightly better performance in persons with overt diabetes mellitus and relatives of patients with diabetes than in nondiabetic individuals without a family history of diabetes. Hence, the FFQ allows measuring intakes of total energy and macronutrients in prediabetes and diabetes cohorts but reveals limitations when assessing dietary composition.     

Are symptoms of depression more common in diabetes? Results from the Heinz Nixdorf Recall study

Aims To estimate the association between depressive symptoms and Type 2 diabetes, as well as previously undetected diabetes, in a large population‐based sample in Germany and to determine associated variables. Methods We used baseline data on 4595 participants (age 45–75 years, 50.2% women) from the German Heinz Nixdorf Recall study, a population‐based, prospective cohort study which started in 2000. Diabetes mellitus was assessed by self report (physician diagnosis or medication), undiagnosed diabetes based on blood glucose levels. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES‐D) scale short form (cut‐off ≥ 15 points). We fitted multiple logistic regression models. Results The prevalence of diagnosed and previously undetected diabetes was 9.3% (95% confidence interval 8.2–11.6) and 7.6% (6.6–8.8) in men and 6.0% (5.1–7.1) and 3.2% (2.5–4.0) in women, respectively. Compared with non‐diabetic women, the prevalence of depressive symptoms was not significantly different in diabetic women (age‐adjusted odds ratio, 95% confidence interval 1.48; 0.98–2.24) and women with undiagnosed diabetes (0.67; 0.33–1.36). In men, the prevalence of depressive symptoms tended to be lower in diabetic than in non‐diabetic subjects (0.62; 0.35–1.09), but the depressive symptoms were significantly less frequent in men with undiagnosed diabetes (0.30; 0.13–0.70). The pattern remained after further adjustment. Significant associations with depressive symptoms were found for co‐morbidities and living without a partner in both women and in men, and for body mass index and activity level in women only. Conclusions After adjustment for relevant covariates, the association between depressive symptoms and Type 2 diabetes was heterogenous in our population‐based study. In subjects with undiagnosed diabetes, however, depressive symptoms were less frequent in men. Co‐morbidities and psychosocial conditions are strongly associated with depressive symptoms.