DECONTAMINAZIONE BATTERICA DEI SITI ALVEOLARI MEDIANTE L'UTILIZZO DEL LASER AD ERBIO

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The epidemiology of Varicella Zoster Virus infection in Italy

<p>Abstract</p> <p>Background</p> <p>The epidemiological importance of varicella and zoster and the availability of an efficacious and safe vaccine have led to an important international debate regarding the suitability of mass vaccination. The objective of the study was to describe the epidemiology of varicella and zoster in Italy and to determine whether there have been changes with respect to observations provided by an analogous study conducted 8 years ago, in order to define the most appropriate vaccination strategy.</p> <p>Methods</p> <p>A number of data sources were evaluated, a cross-sectional population-based seroprevalence study was conducted on samples collected in 2004, and the results were compared with data obtained in 1996.</p> <p>Results</p> <p>The data from active and passive surveillance systems confirm that varicella is a widespread infectious disease which mainly affects children. VZV seroprevalence did not substantially differ from that found in the previous study. The sero-epidemiological profile in Italy is different from that in other European countries. In particular, the percentage of susceptible adolescents is at least nearly twice as high as in other European countries and in the age group 20–39 yrs, approximately 9% of individuals are susceptible to VZV.</p> <p>Conclusion</p> <p>The results of this study can contribute to evaluating the options for varicella vaccination. It is possible that in a few years, in all Italian Regions, there will exist the conditions necessary for implementing a mass vaccination campaign and that the large-scale availability of MMRV tetravalent vaccines will facilitate mass vaccination.</p

The epidemiology of mumps in Italy

In Italy, although vaccination has been recommended for a number of years, vaccination coverage for mumps is still sub-optimal. The objective of the present study was to evaluate the seroprevalence of mumps antibodies in the Italian population, stratified by age, gender and geographical area. The proportion of individuals positive for mumps antibodies remained stable in the age classes 0-11 months and 1 year (25.4% and 30.8%, respectively) and showed a continuous increase after the second year of life. The percentage of susceptible individuals was higher than 20% in persons 2-14 years of age and exceeded 10% in persons 15-39 years of age. No statistically significant differences were observed by gender or geographical area. Comparison between these results and the data obtained from a 1996 survey showed a statistically significant increase in seroprevalence in the age class 2-4 years. No changes were observed in the other age-groups. The results of this study confirm that the efforts made in recent years to improve vaccination coverage within the second year of life should be strengthened. \ua9 2008 Elsevier Ltd. All rights reserved

Shaping immune responses through the activation of dendritic cells–P2 receptors

Dendritic cells (DCs) activate and shape the adaptive immune response by capturing antigens, migrating to peripheral lymphoid organs where naïve T cells reside, expressing high levels of MHC and costimulatory molecules and secreting cytokines and chemokines. DCs are endowed with a high degree of functional plasticity and their functions are tightly regulated. Besides initiating adaptive immune responses, DCs play a key role in maintaining peripheral tolerance toward self-antigens. On the basis of the information gathered from the tissue where they reside, DCs adjust their functional activity to ensure that protective immunity is favoured while unwanted or exaggerated immune responses are prevented. A wide variety of signals from neighbouring cells affecting DC functional activity have been described. Here we will discuss the complex role of extracellular nucleotides in the regulation of DC function and the role of P2 receptors as possible tools to manipulate immune responses

Surgical and pathological changes after percutaneous ethanol injection therapy of thyroid nodules

Abstract Few data exist on the operative and pathological findings in patients having undergone previous percutaneous ethanol injection (PEI) therapy of thyroid nodules. We report here our experience with 13 patients operated on by the same surgical team. Two pathologists, both blinded to the previous PEI treatment, carried out histological evaluation. Reasons for surgery included PEI failure, suspicion of malignancy, and tracheal compression. The operations did not pose any special problem from the technical point of view, and the postoperative courses were uneventful. One patient who had a second operation developed hypoparathyroidism, and laryngeal nerve palsy was never observed. The histological diagnosis was hyperplastic or adenomatous nodule in 12 cases and papillary thyroid cancer in 1. No difficulty was found in evaluating the nodule capsule and surrounding vessels. In two lesions, nuclear enlargement and clearing were identified in thyroid follicles immediately adjacent to necrotic or scarred areas. These changes were considered reactive. In conclusion, patients previously treated by PEI were operated on without special technical problems. Histological diagnosis was not hindered, and there was no difficulty in ruling out malignant lesions. PEI, however, should be performed only by skilled operators, and incidental ethanol seepage throughout the nodule capsule must be carefully avoide

Relationship between thyroid dysfunction and heart failure in older people

Heart failure (HF) is one of the most common chronic diseases, affecting around 8% of older people, with an incidence rate of 10 per 1000 person-years. Besides ageing and classical cardiovascular risk factors, it is well recognized that HF may be worsened by endocrine alterations. The prevalence of thyroid dysfunction, similarly to HF, increases with increasing age and, 5-15% of the entire older population, especially women, suffer from overt or subclinical thyroid dysfunction. Thyroid and heart share a common embryologic origin and an intimate and complex functional relationship and, cardiovascular effects are the most prominent features of thyroid dysfunction. Not only alterations of thyroid hormone synthesis and release are risk factors for cardiac disease, but a mutual relationship has been documented and dysregulation of thyroid hormones represents also a marker for chronic heart disease. Thus, even mild thyroid dysfunction (either in excess or defect) may lead to the development of HF and may increase the risk of cardiovascular events. Consequently, thyroid dysfunction should be ruled out not only in older HF patients with no other identifiable causes but also in those with known cardiovascular risk factors. nonetheless, the lack of randomized clinical trials leaves us with several unresolved key issues as also stated in the latest guidelines for the treatment of thyroid dysfunction,.key issues regarding specific criteria and goals of treatment, as also stated. Future large randomized intervention studies, balancing the risk and benefits of thyroid therapy according to the degree of serum TSH and TH alteration, are clearly warranted

Iodoform induced thyrotoxicosis in the elderly: case report and review of literature

Background. Drug-induced hyperthyroidism is a rare condition linked to dietary supplements, iodine-containing medications and intentional or unintentional over ingestion of levothyroxine; its detection is important since, if left untreated, thyroid storm can develop, carrying a mortality rate of 20-50%. Case presentation. Here we describe the case of an oldest old (84 years) woman, with severe cognitive impairment and immobilization syndrome attending our geriatric ward for aspiration pneumonia. During the fifth day of hospitalization, while pneumonia and respiratory symptoms were improving, tachycardia persisted (heart rate 130 bpm), associated with tremors and lack of sleep. The patient was affected by multinodular goiter and, a diagnosis of thyrotoxicosis was documented by elevated serum free thyroxine and free triiodothyronine levels (4.7 ng/dL and 6.6 ng/L, respectively), associated with undetectable thyroid-stimulating hormone (TSH 0.04mIU/L), elevated urinary iodine excretion (849 μg/L) and normal serum thyroglobulin levels (10 ng/ mL).131I thyroid scan showed diffuse low uptake, suggesting iatrogenic thyrotoxicosis. The patient suffered from immobilization syndrome with bedsores that had been medicated twice a week with iodoform gauzes for one year. Prior to starting the use of iodoform dressings the patient was documented euthyroid. Conclusions. Over the past century, few cases have been described regarding possible severe toxicity caused by the use of iodoform gauzes, all of them presenting with neurovegetative symptoms as vomiting, altered sensor, which disappeared after withdrawn of the medication, but iatrogenic thyrotoxicosis was never demonstrated. Thus, to our knowledge, this is the first report documenting the onset of thyrotoxicosis induced by lasting use of iodoform gauzes

Effect of levothyroxine on cardiac function and structure in subclinical hypothyroidism: A double blind, placebo-controlled study

Subclinical hypothyroidism (sHT) affects 5-15% of the general population; however, the need of lifelong L-T(4) therapy is still controversial. As myocardium is a main target of thyroid hormone action, we investigated whether sHT induces cardiovascular alterations. Twenty sHT patients were randomly assigned to receive placebo or L-T(4) therapy and were followed for 1 yr. Twenty sex- and age-matched normal subjects served as controls. Doppler echocardiography and videodensitometric analysis were performed in all subjects. Myocardium textural parameters were obtained as mean gray levels, which were then used to calculate the cyclic variation index (CVI; percent systolic/diastolic change in mean gray levels). Patients had a significantly higher isovolumic relaxation time (3.1 +/- 0.5 us. 2.6 +/-: 0.6; P < 0.03), peak A (0.77 +/-: 0.16 vs. 0.56 +/- 0.13 m/s; P < 0.01), and preejection/ejection time (PEP/ET) ratio (0.72 +/-: 0.05 vs. 0.57 +/- 0.06; P < 0.03) and a lower CVI (P < 0.0001) than controls. CVI was inversely related to TSH level (P < 0.0001) and PEP/ET ratio (P < 0.01). L-T(4)-treated patients showed a significant reduction of the PEP/ET ratio (P < 0.05), peak A (P < 0.05), and isovolumic relaxation time (P < 0.05) along with a normalization of CVI. Conversely, no changes were observed in the placebo-treated group. In conclusion, sHT affects both myocardial structure and contractility. These alterations may be reversed by L-T(4) therapy