Determinants and dynamics of schooling and child labor in Bolivia

This paper investigates the determinants of primary school enrollment, attendance and child labor in Bolivia from 1999 to 2007. The analysis also aims at identifying the substitution and complementary relationships between schooling and working. Although enrollment rates show a significant improvement, lack of attendance remains an issue. The empirical results reveal that the increase in enrollment is led by indigenous children and those living in urban areas. Moreover, contrary to common belief, being extremely poor and indigenous are the main determinants of school attendance. Although extremely poor children increased their school attendance, they were not able to reduce child labor. However, for indigenous children school attendance and child labor were substitutes, increasing schooling and reducing child labor.Street Children,Primary Education,Education For All,Youth and Governance,Children and Youth

"KLEBSIELLA PNEUMONIAE PRODUTTRICE DI CARBAPENEMASI: EPIDEMIOLOGIA OSPEDALIERA E TRATTAMENTO DELLE INFEZIONI IN TERAPIA INTENSIVA"

La Klebsiella pneumoniae resistente ai carbapenemi ad opera di carbapenemasi di classe A (KPC) sta emergendo come un importante patogeno multiresistente in ambito sanitario. Questo germe, ad oggi, rappresentano una minaccia clinica allarmante. Lo scopo di questo studio è stato inizialmente quello di censire l’epidemia da KPC insorta dall’aprile del 2010 presso l’Azienda Ospedaliero Universitaria Pisana e successivamente quello di descrivere il trattamento e l'esito di infezioni da KPC in una singola Unità di Terapia Intensiva (ICU) del ospedale in esame. Nei 22 mesi in esame sono stati identificati 174 casi di KPC provenienti si dall’area critica (87 pazienti), che dall’area chirurgica (22 pazienti) che da quella medica (65 pazienti). Il numero totale di infezioni è stato di 86, l’incidenza di nuove infezioni è progressivamente aumentata durante il periodo di osservazione e di questo gruppo di pazienti si sono registrati 30 decessi. La seconda parte dello studio, condotto in una singola terapia intensiva di 10 letti medico-chirurgica nel periodo aprile-novembre 2011, è stato di tipo osservazionale retrospettivo. Tutti i pazienti infettati con KPC sono stati arruolati. Identificazione batteriologica e la suscettibilità antibiotica sono stati eseguiti in tutti gli episodi di infezione utilizzando un sistema automatico di microdiluizione in brodo (Vitek® 2). Dopo test microbiologico di conferma la suscettibilità per colistina, imipenem, meropenem, gentamicina, fosfomicina e tigeciclina è stata effettuata anche mediante E-test. Durante il periodo di studio, 24 pazienti (21 maschi, età 53 ± 17 anni) sono stati arruolati e 29 episodi di infezioni KPC sono stati registrati; il 79% dei pazienti erano politraumatizzati e comorbidità importanti erano presenti nel 50% dei pazienti. Il tasso grezzo di mortalità in ospedale è stato del 20,8%. La terapia antibiotica mirata era composta da 2 o più farmaci nel 87,5% dei pazienti. L'analisi comparata della distribuzione cumulativa delle MIC ha mostrato una presenza più consistente di resistenza agli antibiotici testati con il sistema Vitek® 2 rispetto a E-test. Secondo il metodo di suscettibilità la terapia antibiotica empirica è considerabile efficace solo nel 7% del paziente secondo il sistema Vitek® 2 e nel 94% del paziente secondo l’ E-test. Il sequenziamento del gene blaKPC, eseguita in un sottogruppo di sei casi, ha mostrato che si ha produzione di KPC-3. Concludendo, in caso di infezioni nosocomiali da KPC in pazienti politraumatizzati e precedentemente in buona salute queste infezioni possono essere trattate con terapia di combinazione di due o più antibiotici e possono avere un successo sia clinico che microbiologico. Rimane ancora da capire quale sia il metodo microbiologico migliore da utilizzare nella pratica clinica per valutare sensibilità e suscettibilità antibiotica dei ceppi di KPC

Cardiomiopatia post-chemioterapia: curare oggi pensando al domani.

Dilated cardiomyopathy post-chemotherapy. We describe the case of a dilated cardiomyopathy with angiographically normal coronary arteries in a 32-year old man who underwent head and spine radiotherapy and high dose antracicline chemotherapy at the age of 5 year for acute lymphoblastic leukemia. The long-term detrimental cytotoxic effect of remote life-saving chemotherapy should be considered in survivals of leukemia.Descriviamo il caso di un giovane di 32 anni affetto da cardiomiopatia dilatativa con quadro coronarografico normale trattato, all\u27et? di 5 anni, con radioterapia delle meningi e chemioterapia con antracicline ad alte dosi per leucemia linfoblastica acuta. L\u27effetto a lungo termine della citotossicit? di questo trattamento salvavita va considerato nei pazienti guariti da leucemia

The integration of 3D modeling and simulation to determine the energy potential of low-temperature geothermal systems in the Pisa (Italy) sedimentary plain

Shallow, low-temperature geothermal resources can significantly reduce the environmental impact of heating and cooling. Based on a replicable standard workflow for three-dimensional (3D) geothermal modeling, an approach to the assessment of geothermal energy potential is proposed and applied to the young sedimentary basin of Pisa (north Tuscany, Italy), starting from the development of a geothermal geodatabase, with collated geological, stratigraphic, hydrogeological, geophysical and thermal data. The contents of the spatial database are integrated and processed using software for geological and geothermal modeling. The models are calibrated using borehole data. Model outputs are visualized as three-dimensional reconstructions of the subsoil units, their volumes and depths, the hydrogeological framework, and the distribution of subsoil temperatures and geothermal properties. The resulting deep knowledge of subsoil geology would facilitate the deployment of geothermal heat pump technology, site selection for well doublets (for open-loop systems), or vertical heat exchangers (for closed-loop systems). The reconstructed geological-hydrogeological models and the geothermal numerical simulations performed help to define the limits of sustainable utilization of an area's geothermal potential

Lipoprotein(a) in familial hypercholesterolemia: Tips from family history.

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COMPARATIVE EFFECT OF APHERESIS vs ATORVASTATIN/APHERESIS ON MARKERS OF INFLAMMATION IN PATIENTS WITH FAMILIAL HYPERCHOLESTEROLEMIA

Objective: Patients with Familial Hypercholesterolemia (FH) have increased cardiovascular events. Clinical trials have demonstrated that lowering circulating lipid levels by LDL-apheresis has beneficial effects on prognosis. However, whether apheresis vascular effects in FH are related to modulation of pro- and anti-inflammatory cytokines, and whether the combination of apheresis with atorvastatin is able to enhance the putative anti-inflammatory effect of apheresis remains unknown. We examined, in a intra-patient study, the effect of atorvastatin/apheresis vs. apheresis alone on the releasing of circulating pro- and anti-inflammatory markers. Methods: 9 heterozygous patients (56+11 years) with FH (mean cholesterol 385+42 mg/dL) were treated with apheresis alone and afterwards with apheresis plus atorvastatin 40 mg/d. Lipid profiles, serum C-reactive protein, CK, GOT, GGT, the antiinflammatory markers IL-4 and IL-10 and the pro-inflammatory markers INFg and IL-6 were determined before and at 2, 4, 6 and 8 days after apheresis and atorvastatin/apheresis. Results: Treatment with atorvastatin/apheresis significantly reduced lipid profile more than LDL-apheresis alone at each scheduled time. When compared to apheresis alone, combined treatment statistically decreased cholesterol by more than 25-35% at all times and relatively increased IL-4 concentration. The levels of cholesterol in atorvastatin/apheresis patients were inversely correlated with those of IL-4 and IL-10 and positively correlated with IFNg. Conclusion: The combination of atorvastatin with LDL-apheresis decreased serum cholesterol levels more than apheresis alone. Apheresis had an anti-inflammatory effect and the effect of the drug reducing cholesterol levels affects the balance between proand anti-inflammatory cytokines in favor of anti-inflammation contribute

Myeloperoxidase modulation by LDL apheresis in Familial Hypercholesterolemia

<p>Abstract</p> <p>Background</p> <p>Myeloperoxidase (MPO) is a marker of plaque vulnerability and a mechanistic bridge between inflammation and cardiovascular disease, and thus is a suitable target for therapeutic strategy against cardiovascular disease.</p> <p>Methods</p> <p>Since hypercholesterolemia is associated with atherosclerosis and inflammation, we tested whether MPO serum levels were up-regulated in Familial Hypercholesterolemia (FH) and whether acute reduction of total cholesterol (TC) would also reduce MPO concentration. FH subjects undergoing LDL-apheresis (LDL-A) treatment are a paradigmatic clinical model where TC rapidly plunges from extremely high to extremely low levels after selective LDL removal, and then spontaneously rebounds to baseline conditions. This clinical setting allows multiple intra-patient observations at different plasma TC concentrations. We measured MPO levels in serum by ELISA tests, and in peripheral leukocytes by immunofluorescence, to learn whether they were affected by the changes in TC levels. Serum MPO was measured before and serially up to the 14^thday following LDL-A.</p> <p>Results</p> <p>In both serum and peripheral leukocytes, MPO concentrations were <it>i) </it>higher than in sex- and age-matched healthy controls (<it>p </it>< 0.01); <it>ii) </it>decreased with TC reduction; <it>iii) </it>parallel with TC time course; <it>iv) </it>correlated with plasma TC. At regression analysis, plasma TC was the only variable considered that influenced MPO serum levels (<it>β </it>0.022 ± 0.010, <it>p </it>< 0.0001).</p> <p>Conclusions</p> <p>In FH the MPO serum levels were modulated through changes in the TC concentrations carried out by LDL-A. Further study is needed to determine whether reduced MPO levels obtained by LDL-A could have any therapeutic impact.</p

Polidistrectual vascular involvement in Familial Hyperchilomicronemia

A 72-year-old man was referred to our clinic with a lipid profile, under combination therapy with a statin and ezetimibe, characterized by severe hypertriglyceridemia (7230 mg/dl), hypercholesterolemia (374 mg/dl), low HDL-cholesterol (17 mg/dl), and normal circulating Lp"a". The patient had undergone post-traumatic splenectomy and presented a history of systemic hypertension treated medically with well-controlled blood pressure. The patient had also presented in the past abdominal pain with subsequent diagnosis of chronic pancreatitis complicated by diabetes mellitus, well compensated when he came to our attention. Following a pathological exercise test, a coronary angiogram was performed which showed a significant stenosis of the right coronary artery, which was treated successfully with percutaneous coronary intervention. Clinical work-up revealed ectasia of the abdominal aorta (28 mm), non significant bilateral carotid artery disease, and peripheral artery disease of the femoral-popliteal axis symptomatic for intermittent claudication. A lipidogram was also performed and electrophoretic lipoprotein patterns did not vary 2 hours after heparin infusion, pointing to the existence of lipoprotein lipase deficit. Electrophoresis also showed a broadband of chylomicrons at baseline, at the beginning, and at the end of heparin infusion. Hyperchilomicronemia is a rare genetic disorder with an incidence of 1 per 1000000. Following diagnosis, our patient began plasma exchange therapy with subsequent improvement of his lipid profile. At the present time, he is regularly followed up at our clinic and non invasive imaging has excluded any significant progression of atherosclerosis after 2 years of therapy

Routine laboratory tests to risk-stratify patients with chronic coronary artery disease

AbstractBackgroundSeveral biohumoral variables, taken individually, are predictors of prognosis in patients with chronic coronary artery disease (CAD). We hypothesized that taken together, laboratory tests provide prognostic information that is additive to a complete diagnostic work-up.MethodsWe prospectively examined 2370 consecutive patients with chronic CAD, as shown by a >50% coronary stenosis (in 95% of patients), previous coronary revascularization (in 31% of patients), and/or previous myocardial infarction (MI, in 54% of patients). We tested the ability of laboratory and clinical variables to predict future cardiac events (cardiac death and non-fatal MI).ResultsDuring follow-up (median, 46 months), 147 patients (6.2%) died from cardiac causes and 81 (3.4%) experienced a non-fatal MI. Using multivariate analysis, after adjustment for clinical variables (including left ventricular ejection fraction and angiographic extent of coronary stenoses), a high-density lipoprotein cholesterol (HDLc) concentration<35mg/dL (p<0.0001), a neutrophil-to-lymphocyte ratio >2.4 (p=0.0014), and an fT3 serum level<2.1pg/mL with normal thyrotropin (low-T3 syndrome) (p=0.0260) showed an independent and incremental prognostic value, and were associated with an increase in the rate of cardiac events of 86%, 57% and 41%, respectively. When these variables were added to clinical and instrumental variables, the prognostic power of the model increased significantly (global chi-square improvement: from 157.01 to 185.07, p<0.0001).ConclusionLow HDLc, high neutrophil-to-lymphocyte ratio and low-T3 syndrome, both individually and taken together, provide prognostic information that is independent of and incremental to the main clinical and instrumental findings

Tangier Disease: a plasma proteome approach

Background. Tangier disease (TD) is a rare autosomal recessive disorder characterized by a deficiency or absence of high-density lipoprotein caused by mutations in the adenotriphosphatebinding cassette transporter-1 gene (ABCA1). These lead to a defect in cellular cholesterol removal causing the deposition of cholesterol esters throughout reticuloendothelial system. Methods. We enrolled a homozygous TD patient and the heterozygous father. Whole plasmatic extracts were processed and mass spectrometry analyses of peptide fragments were performed on MALDI TOF/TOF equipment. Trypsin digestion produces a constant set of peptide fragments distinctive of each starting protein (finger print). Peptide ions are automatically processed by MASCOT and GPS Explorer software, which provide us the identification of starting proteins. Peaks, indicative of different peptides, also subjected to mass/mass analysis by means of fragmentation in a collision chamber. Such second mass analysis provided aminoacid sequence of peptide and the identification of possible post-translational modifications. Results. The very high sensitivity of the method allowed us to identify plasma proteins less peresented (<1.2 pg/ml). Apolipoprotein A-I, haptoglobin, alpha-2 macroglobulin, fibrinogen beta chain and isoform 1 of alpha-1 antitrypsin (C.I. 95%) resulted to be downregulated, while serotransferrin and Ig kappa resulted upregulated in the homozygous TD patient respect to the heterozygous. The same pattern was also observed by routine assays. Conclusions. The downregulation of the acute phase proteins observed in this case was unexpected. Proteome analyses may help in identification of abnormal metabolic pathways eventually activated in TD