A Case of Chronic Urticaria Due to Dirofharia Infestation

ABSTRACTUrticaria is one of the most common dermatoallergic conditions occurring mainly in children and adolescents and in atopic individuals. The term of chronic idiopathic urticaria (CIU) is used when the pathophysiological mechanisms remain unclear. Chronic infections and parasitic infestations have been suggested to play an important role in the etiology of CIU. In the present paper, we describe a case of chronic, apparently idiopathic urticaria in an adult woman where Dirofilaria has been recognized to play a pathogenic role in the determination of the cutaneous disease

Números : revista de didáctica de las matemáticas

Resumen del autor. Resumen en inglésEn este artículo examinamos el resultado de un problema sobre una situación insólita que fué presentada a estudiantes en contraste con un problema rutinario. El caso particular era calcular el volumen de una pirámide real. El problema fué asignado a estudiantes de trece años, buenos para solucionar el problema. Las respuestas de los estudiantes y sus elecciones de estrategia son analizadas.AsturiasES

Diagnostic implications of albumin messenger RNA detection and cytokeratin pattern in benign hepatic lesions and biliary cystadenocarcinoma

Cytokeratin (CK) patterns and albumin messenger RNA (mRNA) are investigated in 24 patients with benign hepatic lesions (7 patients with focal nodular hyperplasia [FNH], 10 with hepatocellular adenomas [HA], 1 with biliary hamartoma, 4 with biliary cysts, 2 with cystadenomas) and in 8 patients with cystadenocarcinoma, a rare liver malignancy. The lesions and surrounding tissue of the hepatocytic components expressed CK 8 and 18 at immunohistochemistry, whereas the biliary elements evidenced CK 8 and 18 and CK 7 and 19. The albumin mRNA, as detected by in situ hybridization (ISH), revealed different distributions in the hepatocytes of FNH and HA. In the benign biliary lesions, the normal hepatocytes surrounding the tumors expressed albumin mRNA, whereas the biliary structures did not. Interestingly, in the cystadenocarcinomas, albumin mRNA was observed not only in the hepatocytes of residual parenchyma, but also in neoplastic bile duct cells lining the carcinomatous cysts; no signal was identified in the nonneoplastic biliary elements. This indicates that cystadenocarcinomas have a mixed biological phenotype and suggests they could arise either from pluripotent cells or from neoplastic cells that reacquire epigenetic features. Our results suggest two possible diagnostic applications for albumin ISH: on routine sections, it could represent an important tool for distinguishing between cystadenoma and cystadenocarcinoma; and on fine needle biopsy specimens, it could reduce uncertainty between FNH and HA

Indagine nazionale del Gruppo di Studio in Allergologia (GdS-ALL): stato dell’arte dei laboratori allergologici italiani nel 2019

Background: In the last ten years, the introduction of the component resolved diagnosis (CRD) has revolutionized allergy diagnostics with a strong clinical impact in respiratory, hymenoptera and food allergy. However, its use and the diagnostic algorithms implemented by each laboratory seem somewhat different across the national territory. In order to have a clearer picture on how this diagnostics is used in Italy, the Study Group in Allergology (GDS-ALL) of the Italian Society of Clinical Pathology and Laboratory Medicine (SIPMeL) has conducted a survey relating to the year 2019, among Italian laboratories that deal with allergy diagnostics to assess the level of implementation of new technologies, the knowledge and application of the recommended diagnostic algorithms and, more generally, the degree and type of organization adopted. Methods: A questionnaire consisting of 47 items divided into five sections was distributed in January 2020 through the SurveyMonkey (Momentive Inc., San Mateo, CA, USA) platform to public and private laboratories throughout the country. The questions were formulated to investigate aspects relating to the type of laboratory, the number of users served, and the number of allergy tests carried out, the type of requests received and their management, the technologies used and their level of automation, the reference intervals and, finally, the relationship with patients, hospital clinicians and general practitioners. Results: Seventy-four laboratories representing all Italian regions responded to the survey, of which 68% are located in public hospitals, 12% are related to university hospitals and 20% to private structures. 9.9% of the participants stated that they had performed specific IgE on several patients greater than 50, 000/year, 15.5% between 10-50, 000, another 15.5% between 5-10, 000, 31% between 1-5000 and the remaining 28.1%, mainly represented by private structures, with less than 1000 patients per year. Among the methods of investigation, 83% of the participants use the fluoroimmunoenzymatic technique (FEIA) and 21% chemiluminescence assays (CLIA) (4% use both technologies). 85% of the laboratories interviewed perform molecular diagnostics and 29% of them are also equipped with the multiplex platform. Almost all laboratories make use of complete automation: 52% of the participants stated that they include an interpretative comment in the report. More than half of the laboratories claim to have of collaborative relationship with hospital clinicians, and 45% declare that they have a satisfactory relationship with general practitioners. The consultancy activity regarding allergy diagnostics is practiced by more than half of the participants. Conclusions: The results obtained from the survey represent a snapshot of the current situation of Italian allergology laboratories, highlighting how most of them have responded positively to the needs for change related to the increasing request of molecular diagnostics in medical prescriptions. However, improvement in the correct use of the proposed algorithms is still necessary in order to obtain an accurate profile of allergenic sensitization effective in supporting the clinical decision

Autoantibodies in Autoimmune Hepatitis

The detection of diagnostic autoantibodies such as antinuclear antibodies (ANA), anti-smooth muscle antibodies (SMA), anti-liver/kidney microsomal type 1 (anti-LKM1), anti-liver cytosol type 1 (anti-LC1) and anti-soluble liver antigen (anti-SLA) is historically associated with the diagnosis of autoimmune hepatitis.BACKGROUND: The detection of diagnostic autoantibodies such as antinuclear antibodies (ANA), anti-smooth muscle antibodies (SMA), anti-liver/kidney microsomal type 1 (anti-LKM1), anti-liver cytosol type 1 (anti-LC1) and anti-soluble liver antigen (anti-SLA) is historically associated with the diagnosis of autoimmune hepatitis.KEY MESSAGES: When autoimmune hepatitis is suspected, the detection of one or any combination of diagnostic autoantibodies, by indirect immunofluorescence or immuno-enzymatic techniques with recombinant antigens, is a pivotal step to reach a diagnostic score of probable or definite autoimmune hepatitis.CONCLUSIONS: Diagnostic autoantibodies (ANA, SMA, anti-LKM1, anti-LC1, anti-SLA) are a cornerstone in the diagnosis of autoimmune hepatitis. Other ancillary autoantibodies, associated with peculiar clinical correlations, appear to be assay-dependent and institution-specific, and validation studies are needed

Autoimmune liver disease serology in acute hepatitis E virus infection

The etiology of autoimmune hepatitis (AIH) is unknown, though hepatotropic viruses may be potential triggers. Hepatitis E virus (HEV) infection, an increasingly recognized cause of acute hepatitis, has been misdiagnosed as AIH due to the occurrence of autoantibodies during its acute phase. It has also been suggested that HEV infection may lead to or unmask AIH. The HEV seroprevalence has been ascertained in patients with AIH, but the prevalence of AIH-related autoantibodies in patients with HEV infection has not been systematically tested. We aimed to investigate whether acute HEV infection is associated with the presence of AIH-relevant autoantibodies, following the liver autoimmune serology guidelines of the International AIH Group. We tested 48 patients with acute HEV infection. Half of them had at least one autoantibody, 17% two autoantibodies. Anti-nuclear antibody (ANA) were detected in 16 (33%), anti-smooth muscle antibody (SMA) in 10 (21%), and anti-neutrophil cytoplasmic antibody (ANCA) in 7 (14.6%). Of note, two patients showed SMA with VG or VGT patterns and five had ANA with homogeneous appearance, both being typical of AIH type 1. Other AIH-specific autoantibodies were negative. Atypical anti-mitochondrial antibody, without evidence of primary biliary cholangitis, was positive in one patient, disappearing at follow-up. Follow-up (median 12 months) serum was available from seven autoantibody positive patients: two became negative, while five remained positive, although no patient developed AIH to date. In conclusion, autoantibodies are frequently present during acute HEV infection, indicating that HEV should always be excluded before diagnosing AIH. Importantly, a minority of patients with acute hepatitis E develops AIH-specific autoantibodies, and, though they did not progress to autoimmune liver disease in the short-term, they warrant long-term monitoring

EEG Evidence of Posterior Cortical Disconnection in PD and Related Dementias

Electroencephalogram (EEG) reactivity to eyes opening and 12-Hz photic stimulation was investigated in 14 healthy elderly subjects, 21 parkinsonian patients (PD), 7 demented parkinsonian patients (PDD), and 10 patients with Lewy body dementia (LBD) using global field synchronization (GFS). During eyes closed Theta GFS was increased in Parkinson\u2019s disease and patients and alpha1 GFS was decreased in LBD subjects. During 12-Hz intermittent photic stimulation (IPS), reactivity of posterior electrodes was decreased in PD and LBD patients. No reactivity was observed in PDD. Results are consistent with a graded posterior cortical disconnection in parkinsonian syndromes and with a model of dopamine-modulated thalamocortical interplay in visual processing