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COVID-19 , Escabiosis , Humanos , Huésped Inmunocomprometido , Lactante , Ivermectina , SARS-CoV-2 , Escabiosis/complicaciones , Escabiosis/diagnósticoAsunto(s)
Probióticos , Infecciones del Sistema Respiratorio , Niño , Humanos , Atención Primaria de SaludRESUMEN
BACKGROUND: Nosocomial infections are a major public health issue and preventative strategies using probiotics and micronutrients are being evaluated. AIM: To investigate the efficacy of a mixture of Lactobacillus GG and micronutrients in preventing nosocomial infections in children. METHODS: A randomised, double-blind, placebo-controlled trial was conducted in hospitalised children. Children (6 months to 5 years of age) received Lactobacillus GG (6 × 10(9) CFU/day) together with vitamins B and C and zinc or placebo, for 15 days, starting on the first day of hospitalisation. The incidence of gastrointestinal and respiratory nosocomial infections after discharge was determined by follow-up telephone call at 7 days. After 3 months, another telephone call estimated the incidence of further infections during follow-up. RESULTS: Ninety children completed the follow-up. Of 19/90 children with a nosocomial infection (20%), 4/45 children (9%) were in the treatment group and 15/45 (33%) in the placebo group (P = 0.016). Specifically, 2/45 (4%) children in the treatment group vs. 11/45 (24%) children in the placebo group (P = 0.007) presented with diarrhoea. The duration of hospitalisation was significantly shorter in the treatment group (3.9 days ± 1.7 vs. 4.9 ± 1.2; P = 0.003). At the follow-up, a total of 11/45 (24.4%) children in the treatment group had at least one episode of infection compared to 22/45 (48.9%) in the placebo group (P = 0.016). CONCLUSION: A mixture containing Lactobacillus GG and micronutrients may reduce the incidence of nosocomial infections, supporting the hypothesis that this may represent a valid strategy to prevent nosocomial infections.
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Infección Hospitalaria/prevención & control , Lacticaseibacillus rhamnosus/fisiología , Micronutrientes/uso terapéutico , Probióticos/uso terapéutico , Niño , Preescolar , Diarrea/dietoterapia , Diarrea/microbiología , Método Doble Ciego , Femenino , Hospitalización , Humanos , Incidencia , Lactante , Masculino , Placebos , Zinc/uso terapéuticoRESUMEN
AIM: The purpose of the study was to evaluate the efficacy of the guidelines on oral health published by the Italian Health Ministry. STUDY DESIGN: 1239 patients (582 girls and 657 boys) with a mean age of 4.46 (SD 2.81) years were evaluated before application of the guidelines by paediatricians (T0) for the presence of caries, gingivitis, diseases of the oral mucosa, and malocclusion. Only patients aged 6 months, 3 years, 6 years, and 9 years at T0 were taken into consideration. All patients were reevaluated after application of the ministerial guidelines (T1). METHODS: the study took place over a 3-year period. Enrolled patients referred to the outpatient clinics of three paediatricians of the Province of Genoa who strictly applied the ministerial guidelines. STATISTICS: Chi square test analysis was performed to evaluate a statistically significant decrease in the incidence of caries, gingivitis and diseases of the oral mucosa. RESULTS: After a 3-year follow-up collected data underlined a statistically significant decrease in the incidence of dental caries, gingivitis and oral mucosal diseases after implementation of the recommended ministerial guidelines. A statistically significant decrease of malocclusions was also evident in the elder patients (12 years old at T1). CONCLUSION: The accurate implementation of the Guidelines is supported. Only collaboration and increased synergy between paedodontists and paediatricians can fulfill the objectives which were the reason for publishing the "National guidelines for the promotion of oral health and the prevention of oral diseases in developmental age".
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Promoción de la Salud , Salud Bucal , Guías de Práctica Clínica como Asunto , Adolescente , Lactancia Materna , Cariostáticos/uso terapéutico , Niño , Preescolar , Enfermedad Crónica , Atención Dental para Niños , Caries Dental/prevención & control , Femenino , Fluoruros/uso terapéutico , Estudios de Seguimiento , Gingivitis/prevención & control , Adhesión a Directriz , Humanos , Lactante , Italia , Masculino , Maloclusión/prevención & control , Enfermedades de la Boca/prevención & control , Higiene Bucal , Técnica de Expansión Palatina , Pediatría , Derivación y Consulta , Hábitos Linguales , Cepillado Dental/métodosRESUMEN
Infants were recruited in four centres in North-West Italy. 138 infants were assessed for eligibility, 113 ones underwent randomisation and 105 completed the study. Newborns aged less than 10 days of life, with gestational age between 37 and 42 weeks, birth weight from 2,500 to 4,300 g and normal physical examination were recruitable. Premature infants and infants affected by outcomes of perinatal hypoxia or necrotising enterocolitis have been excluded. Patients were randomly assigned to receive five drops containing Lactobacillus reuteri DSM 17938 (108 cfu) with 400 UI of vitamin D3 or only 400 UI of vitamin D3 daily. The primary endpoints concern the administration of pain relieving agents (cimetropium bromide at least three times per week or simethicone at least five times per week) from baseline to 12 weeks. Additional analyses were done on the percentage of infants that switched from an exclusive breastfeeding to a partial or exclusive formula feeding from baseline to 12 weeks. Data concerning the number of calls to the paediatricians and the number of visits at paediatricians' ambulatories due to infantile colic have been collected by paediatrician and analysed. Comparing the two groups, the relative risk was 0.04 (95% confidence interval (CI)=0.01-0.31) for cimetropium bromide, 0.24 (95% CI=0.14-0.41) for simethicone and 0.37 (95% CI=0.17-0.80) for the administration of infant formula, showing a protective action of L. reuteri. The treatment group showed a lower number of paediatric consultations related to episodes of infant colic than the control group (P<0.0001). L. reuteri DSM 17938 supplementation at the tested dosage could reduce parental discomfort due to infantile colic. The consumption of this probiotic is associated with a reduction of paediatric consultations for infantile colic, as well as use of pain relieving agents and of infant formula.
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Cólico/prevención & control , Limosilactobacillus reuteri/fisiología , Probióticos/administración & dosificación , Administración Oral , Lactancia Materna , Cólico/metabolismo , Cólico/microbiología , Suplementos Dietéticos , Femenino , Humanos , Lactante , Fórmulas Infantiles/metabolismo , Recién Nacido , Masculino , Leche Humana/metabolismo , Estudios ProspectivosRESUMEN
Since children with chronic diseases represent a primary target for immunization strategies, it is important that their immunization coverage and timeliness of vaccines is optimal. We performed a study to measure immunization coverage and timeliness of vaccines in children with type 1 diabetes, HIV infection, Down syndrome, cystic fibrosis, and neurological diseases. A total of 275 children aged 6 months-18 years were included in the study. Coverage for diphtheria-tetanus-pertussis (DTP), polio (Pol), and hepatitis B (HBV) vaccines approximated 85% at 24 months, while measles-mumps-rubella (MMR) coverage was 62%. Immunization coverage for seasonal influenza was 59%. The analysis of timeliness revealed that there was heterogeneity among children with different chronic diseases. A proportional hazard model showed that children with HIV infection had the longest time to complete three doses of DTP, Pol, and HBV, and those with neurological diseases received the first dose of MMR later than the other categories. Causes of missing or delayed vaccination mostly included a concurrent acute disease. Children with chronic diseases should be strictly monitored for routine and recommended vaccinations, and health care providers and families should be properly informed to avoid false contraindications.
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Enfermedad Crónica/prevención & control , Programas de Inmunización/estadística & datos numéricos , Esquemas de Inmunización , Vacunación/estadística & datos numéricos , Adolescente , Niño , Preescolar , Enfermedad Crónica/epidemiología , Control de Enfermedades Transmisibles/métodos , Estudios Transversales , Vacuna contra Difteria, Tétanos y Tos Ferina/administración & dosificación , Femenino , Vacunas contra Hepatitis B/administración & dosificación , Humanos , Programas de Inmunización/normas , Lactante , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Entrevistas como Asunto , Italia/epidemiología , Masculino , Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificación , Vacunación/normasRESUMEN
AIMS: Permanent neonatal diabetes is a rare condition affecting 1 in 300,000-400,000 live births; only in 60% of cases it is possible to identify the genetic defect. The condition of pancreatic agenesis is rarer still. Only two genes are known to determine this phenotype: PDX-1 and PTF1A. Congenital heart defects are among the most common developmental anomalies, affecting 1% of newborns, and the GATA4 gene is less frequently involved in these disorders. An Italian child with pancreatic agenesis and an atrial septal defect was genetically investigated to elucidate whether the association of the two pathologies was casual, or represented a new pancreatic/cardiac syndrome. METHODS: A panel of pancreas development genes, including GCK, Kir6.2, PTF1A, PDX-1, HNF-1A, NgN3, SOX17, SOX7, SOX9, INS, HNF1-B and SUR1 plus the GATA4 gene, were screened for characterization of pancreatic agenesis and cardiac defect. RESULTS: Screening for genes causing permanent neonatal diabetes was negative. A novel mutation in GATA4 (c1512C>T) was detected and functional characterization confirmed a reduced activity of the protein. In the family members, the GATA4 mutation co-segregates with a cardiac phenotype, but not with pancreatic agenesis. CONCLUSIONS: We describe the first report of pancretic agenesis with an associated cardiac defect and a mutation in the GATA4 gene. We could not establish that the GATA4 mutation was causative for pancreatic agenesis and further genetic investigation to detect the genetic cause of the pancreas agenesis was unsuccessful. We conclude that, the two pathologies are attributable to two independent events.
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Diabetes Mellitus Tipo 1/genética , Factor de Transcripción GATA4/genética , Defectos del Tabique Interatrial/genética , Preescolar , Anomalías Congénitas/genética , Análisis Mutacional de ADN , Diabetes Mellitus Tipo 1/diagnóstico , Defectos del Tabique Interatrial/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Mutación , Páncreas/anomalíasRESUMEN
The objective of this document is to identify and reinforce current recommendations concerning the management of HIV infection in infants and children in the context of good resource availability. All recommendations were graded according to the strength and quality of the evidence and were voted on by the 57 participants attending the first Italian Consensus on Paediatric HIV, held in Siracusa in 2008. Paediatricians and HIV/AIDS care specialists were requested to agree on different statements summarizing key issues in the management of paediatric HIV. The comprehensive approach on preventing mother-to-child transmission (PMTCT) has clearly reduced the number of children acquiring the infection in Italy. Although further reduction of MTCT should be attempted, efforts to personalize intervention to specific cases are now required in order to optimise the treatment and care of HIV-infected children. The prompt initiation of treatment and careful selection of first-line regimen, taking into consideration potency and tolerance, remain central. In addition, opportunistic infection prevention, adherence to treatment, and long-term psychosocial consequences are becoming increasingly relevant in the era of effective antiretroviral combination therapies (ART). The increasing proportion of infected children achieving adulthood highlights the need for multidisciplinary strategies to facilitate transition to adult care and maintain strategies specific to perinatally acquired HIV infection.
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Antirretrovirales/uso terapéutico , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Adulto , Terapia Antirretroviral Altamente Activa , Niño , Preescolar , Manejo de la Enfermedad , Progresión de la Enfermedad , Femenino , Infecciones por VIH/transmisión , Humanos , Lactante , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Italia , EmbarazoRESUMEN
Human papilloma virus infection is thought to play a role in laryngeal carcinogenesis; the variable association reported in literature may be due to wide range of HPV genotypes. We report the case of a 51-year-old man affected by laryngeal squamous cell carcinoma; analysis of DNA extracted by cancer cells by an innovative molecular virology assay (INNO-LiPA HPV Genotyping Extra) showed the presence of two high-risk HPV genotypes, HPV-73 and -82. Immunohistochemical examination confirmed positivity for both capsid protein and viral oncogenic protein E7. Such association has never been reported in literature so far, and a brief discussion on the importance of assessing HPV status in laryngeal cancer is provided.
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Carcinoma de Células Escamosas/virología , Neoplasias Laríngeas/virología , Papillomaviridae/clasificación , Infecciones por Papillomavirus/virología , Biopsia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Sondas de ADN de HPV , Genotipo , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Laringectomía , Laringe/patología , Laringe/virología , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Disección del Cuello , Estadificación de Neoplasias , Papillomaviridae/genética , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/patología , Infecciones por Papillomavirus/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Nutrition has a key role in the modulation of the developing intestine in early infancy, and nutrients are able to modulate several intestinal functions including nutrient absorption, ion transport, cell growth and differentiation, motility and immunomodulation. Such modulation is exerted in part through a direct interaction between a single nutrient and the enterocyte. Two functions--ion transport and cell growth--are closely connected and appear to be modulated by nutrients. This is supported by the finding that a single nutrient (e.g. zinc) stimulates ion absorption and also promotes enterocyte growth. Interestingly, intracellular signalling for either effect is similar and involves mitogen-activated protein kinase. Other nutrients also modulate enterocyte function and there is evidence that their effect may depend on their side of action (apical or basolateral) and concentration. Knowledge of the interaction between nutrients and enterocytes may be exploited to obtain clinical effects using nutrition as a long-term treatment for intestinal and non-intestinal conditions.
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Proliferación Celular , Enterocitos/fisiología , Alimentos , Mucosa Intestinal/metabolismo , Transporte Iónico/fisiología , Proliferación Celular/efectos de los fármacos , Desarrollo Infantil/efectos de los fármacos , Desarrollo Infantil/fisiología , Enterocitos/efectos de los fármacos , Enterocitos/metabolismo , Humanos , Recién Nacido , Intestinos/crecimiento & desarrollo , Transporte Iónico/efectos de los fármacos , Modelos BiológicosRESUMEN
BACKGROUND: The main contribution to genetic susceptibility for Type 1 Diabetes Mellitus (T1DM) is conferred by the Human Leukocyte Antigens (HLA). AIM: We evaluated the feasibility of large scale screening on Dried Blood Spot (DBS) to estimate the genetic risk for T1DM in newborns. SUBJECTS AND METHODS: Peripheral blood DBS samples from 256 newborns, were genotyped for HLA DRB1 and DQB1 alleles identification by a commercially available assay based on a dissociation enhancer lanthanide fluorescence system available in many newborn screening laboratories. Results were compared with those obtained in two wide multicentric studies on cord blood (DIABFIN and PREVEFIN). RESULTS: Genotyping on DBS revealed 6 subjects at high risk for T1DM, 99 at moderate risk for T1DM and the remaining at low risk for T1DM. We found 100% concordance between both techniques for HLA-DQB1 and DRB1 determination, confirming the feasibility of large scale screening on DBS. CONCLUSIONS: DBSs represent a resource for future studies about new genetics markers. This assay for estimate the genetic risk of T1DM on DBS showed an excellent sensitivity, specificity and accuracy compared with conventional techniques. Moreover, this assay resulted less expensive, and it could be easily performed on material already collected for newborn screening programs.
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Diabetes Mellitus Tipo 1/genética , Predisposición Genética a la Enfermedad , Antígenos HLA-DQ/análisis , Antígenos HLA-DR/análisis , Recién Nacido/sangre , Tamizaje Neonatal/métodos , Genotipo , Cadenas beta de HLA-DQ , Cadenas HLA-DRB1 , Humanos , Recién Nacido/inmunología , Sensibilidad y EspecificidadRESUMEN
AIMS: To assess plasma concentrations of folic acid, vitamin B12, and total plasma homocysteine (tHCY) during fasting and after methionine load in young patients with Type 1 diabetes mellitus (T1DM). METHODS: We enrolled 41 young patients with T1DM without any sign of microvascular complications and 123 healthy controls in a 1:3 case-control study. Fasting and post-methionine load (PML) tHCY, folic acid, and vitamin B12 levels were measured in both groups. Data regarding chronological age, metabolic control (assessed by mean values of glycated hemoglobin in the last 12 months) and disease duration were also recorded. RESULTS: Fasting and PML tHCY levels were significantly lower in patients than in controls: 7.3+/-2.7 micromol/l vs 8.3+/-2.5 micromol/l (p=0.01), and 16.7+/-5.8 micromol/l vs 17.3+/-4.3 micromol/l (p=0.01), respectively. No correlation was found between fasting and PML tHCY levels and chronological age, disease duration, metabolic control, and insulin requirement. Patients had significantly higher vitamin B12 levels compared to controls: 767+/-318 pg/ml vs 628+/-236 pg/ml (p=0.003), while folic acid turned out to be lower in patients than in controls: 5.3+/-1.9 nmol/l vs 7.5+/-2.6 nmol/l (p<0.0001). CONCLUSIONS: Adolescents and young adults with T1DM without microvascular complications showed lower tHCY both during fasting and after methionine load. Lower folate concentrations in these patients might benefit from food fortification.
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Diabetes Mellitus Tipo 1/sangre , Ayuno/metabolismo , Ácido Fólico/sangre , Homocisteína/sangre , Metionina , Vitamina B 12/sangre , Adolescente , Adulto , Envejecimiento/fisiología , Glucemia/metabolismo , Estudios de Casos y Controles , Niño , Femenino , Humanos , Masculino , Caracteres Sexuales , Adulto JovenRESUMEN
Chronic mucocutaneous candidiasis (CMC) is a syndrome characterised by immune deficiency, often presenting familial dominant inheritance and association with autoimmune endocrinopathies. We report on a patient with CMC who died at 5 years of age of a brain haemorrhage following the rupture of a basilar-artery aneurysm. Candida hyphae in the basilar artery were found at autopsy. A common immunologic abnormality in CMC is the failure of patient's T-lymphocytes to produce cytokines, which are essential for expression of cell-mediated immunity to Candida. Therefore, long-term treatment is mandatory.
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Candidiasis Mucocutánea Crónica/complicaciones , Aneurisma Intracraneal/etiología , Candidiasis Mucocutánea Crónica/diagnóstico , Angiografía Cerebral , Diagnóstico Diferencial , Resultado Fatal , Humanos , Lactante , Aneurisma Intracraneal/diagnóstico , Masculino , Tomografía Computarizada por Rayos XRESUMEN
The World Health Organization (WHO) has stated that preparedness for effectively facing a major influenza epidemic should involve the training of physicians in the management of contagious diseases and upgrading hospital resources and procedures [1]. Children would be particularly vulnerable during an influenza pandemic and specific measures are needed to face the threat to them effectively. We performed a national survey to obtain information about the preparedness in facing a major influenza outbreak in Italian paediatric units. In Italy, paediatrics clinics are found in both paediatric wards and paediatric departments. Departments are more complex structures, containing several units with different specialisations and facilities. For this study, we interviewed heads of both departments and units. A structured questionnaire, including 30 items, was submitted to the heads of 150 paediatric hospital departments across the country. Responses were obtained from 123 units; 10% of these had rooms dedicated to infectious diseases, and 4% had experts in infectious diseases available and routinely applied procedures for preventing the spreading of acute infectious diseases. Only 8% of departments have paediatric intensive care facilities. Few paediatric units, usually located in large children's hospitals or in academic paediatric departments, have a sufficient degree of preparedness to face severe influenza pandemics. A structural improvement of the paediatric units and the use specific procedures are essential for effectively care for children hospitalised because of contagious diseases.
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Planificación en Desastres/organización & administración , Brotes de Enfermedades/prevención & control , Subtipo H5N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Pediatría/organización & administración , Niño , Brotes de Enfermedades/estadística & datos numéricos , Administración Hospitalaria , Humanos , Incidencia , Gripe Humana/diagnóstico , Gripe Humana/prevención & control , Italia/epidemiología , Vigilancia de la Población , Medición de Riesgo/métodos , Factores de RiesgoRESUMEN
AIM: To evaluate clinical and genetic factors, besides pancreatic insufficiency, associated with increased risk of cystic fibrosis-related diabetes. METHODS: Case-control (1:1) study on 138 cystic fibrosis patients. Data were collected on gender, age at diagnosis, reason for cystic fibrosis diagnosis, family history of type 1 or 2 diabetes mellitus, pre-existing severe liver disease, and class of cystic fibrosis transmembrane regulation mutation. Moreover, information was obtained on lung involvement and degree of exocrine pancreatic insufficiency evaluated 1 year before the diagnosis of cystic fibrosis-related diabetes in patients and age-matched controls. RESULTS: Compared to controls, patients with cystic fibrosis-related diabetes had a higher probability of having already been diagnosed with liver disease (16.7% versus 1.7%, OR = 11.6, 95% CI 1.43-93.0). Moreover, in the year before diabetes onset, cases had slightly worse pulmonary function compared to controls (FEV1 = 58.4 +/- 27% predicted versus 67.4 +/- 21% predicted; p = 0.05). No significant effects related to the other factors considered were found. CONCLUSION: Severe liver disease was found to significantly increase the risk of developing cystic fibrosis-related diabetes. Patients with liver disease should be scheduled for earlier diabetes screening in order to identify and possibly treat glucose intolerance.
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Fibrosis Quística/epidemiología , Diabetes Mellitus/epidemiología , Hepatopatías/epidemiología , Adolescente , Adulto , Estudios de Casos y Controles , Comorbilidad , Fibrosis Quística/fisiopatología , Diabetes Mellitus/fisiopatología , Humanos , Factores de RiesgoRESUMEN
Costello syndrome is characterized by facial dysmorphia, hyperpigmented skin, palmar and plantar hyperkeratosis, curly hair, perioral and nasal papillomata (more rarely localized anally and on vocal cords), short stature, mental retardation and sociable personality. Although growth retardation is typical of Costello syndrome, its cause is not defined. We report on a 10-yr-old Caucasian girl affected by Costello syndrome with fasting hypoglycemia and short stature, associated low circulating levels of acid-labile subunit (ALS), relatively low levels of IGF-I and IGFBP-3, and normal IGF-II, mostly circulating in a binary complex with IGFBP-2 and -6 instead of in a 150 kDa ternary complex. The reduced ALS concentration and the consequent impaired formation of the circulating 150 kDa ternary complex can induce an accelerated clearance rate of IGF peptides and of IGFBP-3, contributing to the decreased IGF-I growth promoting activity in our patient. Moreover, the presence of IGF-II in the binary complex, which has been postulated to increase the insulin-like effects of these peptides, can explain, at least in part, the patient's asymptomatic fasting hypoglycemia.
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Anomalías Craneofaciales , Trastornos del Crecimiento , Hiperpigmentación , Somatomedinas/análisis , Proteínas Portadoras/sangre , Anomalías Craneofaciales/sangre , Anomalías Craneofaciales/complicaciones , Femenino , Glicoproteínas/sangre , Trastornos del Crecimiento/sangre , Trastornos del Crecimiento/complicaciones , Humanos , Hiperpigmentación/sangre , Hiperpigmentación/complicaciones , Hipoglucemia , Lactante , Proteína 2 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Proteína 6 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Factor II del Crecimiento Similar a la Insulina/análisis , Discapacidad Intelectual/sangre , Discapacidad Intelectual/complicaciones , Queratodermia Palmoplantar/sangre , Queratodermia Palmoplantar/complicaciones , SíndromeRESUMEN
AIM: To investigate the role of inhaled corticosteroids (IC) on the risk of Pseudomonas aeruginosa acquisition before the age of 10 y in cystic fibrosis (CF) patients. METHODS: For each subject the cumulative dose kg(-1) of IC received for each year of age was calculated until the end of follow-up. The age at CF diagnosis, the nutritional status (NS) and the number of respiratory exacerbations (RE) were used as surrogate measures for the severity of CF. RESULTS: A total of 83 patients (40 M, 43 F) entered the study. Their median length of follow-up was 4.4 y, for a total of 386 person-years at risk. Twenty-three patients acquired P. aeruginosa at a median age of 4.6 y (range 0.4-9.9 y). The estimated survival without P. aeruginosa acquisition was 65% at 10 y of age. The effect of different risk factors (IC, NS, RE and age at CF diagnosis) on the probability of P. aeruginosa acquisition was evaluated: none of them was significantly associated with the risk of P. aeruginosa acquisition. In particular, patients receiving very high cumulative doses of IC (4th quartile) had a non-significantly increased risk of P. aeruginosa acquisition compared with those receiving low doses of IC (1st quartile) (hazard ratio = 1.73, 95% confidence limits 0.40-7.38). CONCLUSION: This retrospective study was not able to demonstrate any role of IC in increasing the risk of P. aeruginosa acquisition. This complication seems to occur at a constant pace that is independent of CF severity and age. Prospective multi-institutional randomized studies are needed to investigate the effects of high-dose IC in CF patients.
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Corticoesteroides/efectos adversos , Fibrosis Quística/complicaciones , Infecciones por Pseudomonas , Administración por Inhalación , Corticoesteroides/administración & dosificación , Niño , Preescolar , Fibrosis Quística/clasificación , Fibrosis Quística/tratamiento farmacológico , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Lactante , Recién Nacido , Italia/epidemiología , Masculino , Estado Nutricional , Prevalencia , Infecciones por Pseudomonas/complicaciones , Infecciones por Pseudomonas/epidemiología , Infecciones por Pseudomonas/etiología , Pseudomonas aeruginosa/patogenicidad , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
Apoptosis has a major role in molding the embryo, in the maintenance of tissue homeostasis, and in the defense against pathogens, while its disgregulation is strongly implicated in cancer as well as in autoimmune and degenerative diseases. The opposite action of anti-apoptotic proteins (Bcl-2 family) and pro-apoptotic proteins (p53, Bax, Bak) regulates the activation of caspases that are the effectors proteases of the cell suicide. Bcl-W is a pro-survival protein, recently discovered, related to the Bcl-2 family. The presence of Bcl-W is fundamental for spermatogenesis in rats. Caspases are cysteine-dependent aspartate-specific proteases, and their over-expression can result in apoptotic cell death. Normally, caspases exist in cells as inactive pro-enzymes and can be activated by 2 distinct mechanisms: the FADD/caspase 8 cascade, and the Apaf-1/caspase 9 cascade. These 2 mechanisms are used extensively by cells for the activation of the effectors caspases: caspase 3, caspase 6, and/or caspase 7. Bcl-W and caspases might have a pivotal role in maintenance of Sertoli cells integrity. In this study, we demonstrate that both Bcl-W mRNA and caspase 3 mRNA are expressed in isolated Sertoli cells of pre-puberal rat testes. This finding might be crucial in clarifying whether Sertoli cells die by an apoptotic mechanism. Further studies are required to understand whether the expression of Bcl-W and caspases is different before and after puberty in rat testis and/or in pathological conditions, that lead to an increased cell apoptosis.
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Caspasas/genética , Proteínas/genética , ARN Mensajero/análisis , Células de Sertoli/química , Animales , Apoptosis , Caspasa 3 , Expresión Génica , Masculino , Proteínas Proto-Oncogénicas c-bcl-2 , Ratas , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Maduración Sexual , Testículo/química , Testículo/crecimiento & desarrolloRESUMEN
Human spermatozoa are more dependent on glutathione peroxidase/glutathione reductase (GPX/GR) system, via reduced glutathione (GSH), to inactivate reactive oxygen metabolites (ROMs) such as hydrogen peroxide and organic hydroperoxides. To demonstrate whether there is a substantial difference in GPX activity between normal and pathological seminal plasma, we decided to evaluate the activity of this enzyme in healthy subjects and infertile males with normal hormonal patterns. Our results demonstrate that in healthy subjects the seminal plasma contains a GPX activity that is about 10 times greater than the GPX activity detected in the seminal plasma of infertile males. By using specific antibodies against plasmatic GPX (GPX3), we also demonstrate that enzymatic activity, detected in the seminal plasma of both healthy and infertile males is GPX3. Therefore, the evaluation of GPX activity in human seminal plasma could be a new useful marker of gonadal function in men.