Analysis of a direct access testing system for the detection of SARS-CoV-2 in the paediatric population attending school.

Background: During the COVID-19 pandemic, the paediatric population plays a minor role in the spread of the SARS-CoV-2 virus. However, in order to keep schools open and reduce SARS-CoV spreading, it is necessary to identify and isolate early SARS-CoV-2 positive paediatric patients even if they are asymptomatic. The aim of this study was to describe a setting for SARS-CoV 2 testing based on the spontaneous presentation of paediatric patients attending school without a medical prescription and explore its appropriateness. Study design: Cross-sectional study. Methods: The study performed between September 2020 and March 2021 among a sample of 13,283 paediatric patients who underwent a swab in four different hospital settings (school hot spot, emergency department, day hospital setting and hospital wards). For each patients we collected: date of swab execution, type of swab, execution setting of the swab, result of the swab, information about community spread of the virus in the 14 days prior to the swab execution, sex and age. Results: In our sample, females accounted for 45.8%. The median age was 6.8 years (IQR 3.0-11.2) and the most frequent age category was between 6 and 11 years (27.9%). At multivariable models with a swab tested positive as outcome. The swabs executed in all the hospital settings had a lower likelihood of resulting positive compared with the school hot spot setting. Compared with adolescents aged between 14 and 19 years old, new-borns below 3 months (adjOR 1.83, 95% C.I. 1.14-3) and patients aged between 11 and 14 years old (adjOR 1.32, 95% C.I. 1.07-1.63) reported a higher probability of a swab tested positive. Instead, children aged between 3 months and 3 years (adjOR 0.77, 95% C.I. 0.61-0.96) and children aged between 3 years and 6 years (adjOR 0.66, 95% C.I. 0.53-0.83) were less likely to result positive. The higher was the mean of pooled Rt in the 14 days preceding the swab, the higher was the likelihood of resulting positive (adjOR 1.75, 95% C.I. 1.53-1.99). Conclusion: In conclusion, we found a high incidence of paediatric patients positive to the test for the detection of SARS-CoV-2 at the school hot spot compared with other settings during the period of observation. The free access modality to the nasopharyngeal swab was effective in identifying patients with COVID-19. Public health authorities should implement these testing modality in order to help reduce the spread of SARS-CoV-2 in school settings.

[Organization and management of clinical-care pathways at the Regina Margherita Hospital in Turin during Covid-19 emergency]. / L'emergenza COVID-19 in ambito pediatrico: esperienze di gestione ed organizzazione dei percorsi clinico-assistenziali dell'Ospedale Infantile Regina Margherita di Torino.

The Covid-19 pandemic significantly increased the workload for the Italian Health Service. There is few information in the literature on the pediatric population and on the management of pediatric hospitals. The aim of this article is to describe the management of healthcare services during Covid-19 emergency in Regina Margherita Children's Hospital. The Regina Margherita Children's Hospital is specialized in the prevention, diagnosis and treatment of pediatric diseases. About 1000 health worker work in this Hospital and 278 hospitalization places are available.

The effectiveness of oral goat colostrum in the treatment of patients with type 2 diabetes mellitus: our preliminary experience.

INTRODUCTION: The properties of colostrum were recognized and investigated more thoroughly in the first half of the eighties, when the immune factors and growth factors it contains were pointed out. Numerous studies show that the administration of colostrum benefits the subjects with type 2 diabetes mellitus as it gradually regulates appetite, improves utilization of nutrients, especially glucose, and leads to a significant decrease in body fat. MATERIALS AND METHODS: The following study is aimed at verifying a possible reduction in the use of insulin in 27 subjects with type 2 diabetes, treated with goat colostrum in the form gastro-resistant tablets of 300 mg (4/die). RESULTS: In subjects with type 2 diabetes treated with insulin, the administration of colostrum has obtained a significant reduction of insulin dosage and normalization of blood glucose levels. CONCLUSIONS: The effects of colostrum are presumably linked to increased levels of IGF-1 that improves the utilization of glucose, stimulates glycogen and protein synthesis.

Chronic urticaria with high IgE levels: first results on oral cyclosporine A treatment.

INTRODUCTION: Chronic Urticaria is a difficult to define condition from the nosographic standpoint, with complex pharmacological management, that heavily impacts the life of the patient. Some forms show not to be responsive to anti H1 anti-histaminic and require other treatments. One of these can be the treatment with Cyclosporine A (CsA). MATERIALS AND METHODS: This study, open and sequential, reports the results of short-term treatment over a sample of adults (21 patients) of both sexes, all suffering from chronic urticaria with IgE levels higher than 200 mU/ml treated with 4 mg/kg/die of CsA. RESULTS: The results obtained show a reduction in the levels of total IgE and a significant improvement in symptoms; there were no adverse effects. CONCLUSIONS: Cyclosporine is an excellent treatment for chronic urticaria because it reduces the activity of T lymphocytes and reduction of the histamine release from the mast cells and basophils.

[Organization analysis and health technology assessment: an experiment in San Giovanni Battista University Hospital-Turin]. / Analisi organizzativa e health technology assessment: un progetto sperimentale presso l'Azienda Ospedaliero Universitaria san Giovanni Battista di Torino.

Recent Italian laws emphasise Clinical Governance model as a priority for hospitals and Health Technology Assessment as one of the major tools in order to support local and hospital decisions as far as new health technologies are concerned. Our reported experience suggests managing solutions and appraises clinical issues in terms of effectiveness, efficiency and security of new and emerging technologies in order to plan and to create a system according to up to date Health Technology Assessment principles in San Giovanni Battista University Hospital-Turin. Mini-HTA reports have been realised on "Technology Intelligence" in prostate cancer treatment, percutaneous implantation of aortic valve prosthesis in high-risk patients with aortic valve disease and experimental Home Radiology project. In addition, 1167 health technologies have been evaluated through a database created ad hoc. 65% of the evaluations have been positive, less than 5% negative and the other 30% have been suspended waiting for deeper assessments. The future perspectives predict the realization of further Mini-HTA reports even through a revision of the managing model used.

Intravenous IgG: biological modulating molecules.

Intravenous IgG has been adopted as treatment for various immune-related diseases, including immune thrombocytopenic purpura, autoimmune neuropathies, systemic lupus erythematosus, Guillain-Barré syndrome, myasthenia gravis, Kawasaki disease, skin blistering diseases. The intravenous administration of exogenously pooled human immunoglobulin was originally licensed as antibody replacement therapy in patients with primary immunodeficiencies, but in the last thirty years, despite a current lack of institutional approval, off-label IVIgG treatment of a consistent number of disorders has shown to be a useful approach with good clinical results. The mechanism of action of IVIgG is complex and is not fully understood. The current understanding and development in the immune modulant action of IVIgG has three basic mechanisms: 1) F(ab')2 mediated actions; 2) interaction of IgGFc molecule with Fc receptors (FcgammaR); 3) actions mediated by complement fractions binding within the Fc molecular structure. The mode of action of IVIgG involves expression and function of Fc receptors, idiotype network, complement and cytokine network, T and B cell differentiation, modulation of antigen-presenting cells (APC). The therapeutic action of IVIgG is also related to natural antibodies in maintaining immune homeostasis. In addition, IVIgG interaction through V regions with complementary V regions of antibodies may provide a rational basis for selection of various immune repertoires. Since there is a significant gap between the institutional approval and the use of IVIgG in various clinical conditions, for which there is no adequate testing or for which a small number of records does not allow a rigorous statistical approach, several public and private institutions (mostly insurance companies) and research centres have developed guidelines for evaluating a rational and deontological approach in various pathological situations where IVIgG is used. Mathematical models based on non-linear differential equations may represent another potentially useful system to better understand an IVIgG targeted use in individual subjects.

Protein profile of Helicobacter pylori strains by isoelectrofocusing in patients affected by chronic gastritis.

BACKGROUND: To understand if relapse, following antimicrobial treatment was due to re-infection or to recrudescence. METHODS: Fifty patients with dyspepsia were studied prospectively. They were followed up by endoscopy and biopsy of antral mucosa before and after treatment with anti-microbial therapy. Gel isoelectrofocusing was used to characterize protein profile of Hp. RESULTS: At baseline 40 patients were affected by chronic gastritis associated with Hp. At the end of treatment 75% patients given omeprazole, amoxicillin and clarithromycin were Hp infected: 43% showed the same protein profile and 57% different. CONCLUSIONS: Our data suggest that the relapse is due to recrudescence or to reinfection.

Effect of different carbon sources and cold shock on protein synthesis by a psychrotrophic Acinetobacter sp.

The induction of proteins after a 25 to 5 degrees C cold shock in the psychrotrophic Acinetobacter HH1-l was examined using two-dimensional polyacrylamide gel electrophoresis. In addition, effects of various carbon sources (acetate, Tween 80, and olive oil) on protein synthesis after cold shock were assessed. HH1-1 responded to cold shock by synthesizing both cold shock proteins (csps) and cold acclimation proteins (caps). The synthesis of two csps (89 and 18) was increased 2 h after cold shock by the cells, regardless of the carbon source provided. An additional csp (csp 12), with an estimated molecular mass of 12 kDa, was observed in cells grown in olive oil only. Csp 12 was also synthesized when cells were incubated at 30 degrees C, suggesting that this protein may serve as a general stress protein. In addition to csps, caps were observed post cold shock at 72 h in acetate-grown cells and at 140 h in cells grown in Tween 80 and olive oil. Induction of cold-acclimated periplasmic proteins was observed for cells grown in olive oil only, suggesting cells grown in olive oil may be stressed by low temperatures to a greater extent than cells grown in either acetate or Tween 80.

Effects of low temperature, cold shock, and various carbon sources on esterase and lipase activities and exopolysaccharide production by a psychrotrophic Acinetobacter sp.

The activities of isocitrate lyase, esterase, and lipase by the psychrotrophic Acinetobacter sp. strain HH1-1 were monitored during incubation at 25 degreesC, 5 degreesC, and after a 25 degreesC to 5 degreesC down shift in growth temperature. During growth at 25 degreesC, isocitrate lyase activity was detected in cell-free extracts, but at 5 degreesC and after cold shock, activity was measured primarily in the cell culture supernatant. Strain HH1-1 produced two cell-associated esterases and an extracellular esterase and lipase. Activities of the extracellular esterase and lipase were reduced when cells were grown at 5 degreesC and after cold shock. In contrast, an increased synthesis of a 53-kDa cell-associated esterase was observed 50 h after cold shock. An extracellular polysaccharide was also produced, indicated by a decrease in surface tension in cell culture supernatant when cells were incubated at 25 degreesC; but like extracellular enzyme activity, production of the exopolymer was reduced when cells were subjected to low temperatures. These results indicated that the intracellular enzyme, isocitrate lyase, leaked out of the cell after cold shock and during growth at 5 degreesC. The increased activity of a cell-associated esterase suggested this enzyme is required for growth at low temperatures. In contrast, activities of extracellular lipolytic enzymes and production of an extracellular polysaccharide were negatively affected at the lower temperatures.

Heat-shock-proteins-antibodies in patients with Helicobacter pylori associated chronic gastritis.

Twenty eight patients (15 F, 13 M mean age 37.7 SD +/- 9.93 range 22-55) affected by Helicobacter Pylori infection associated gastritis were studied. HSP 70 Antibodies were found in 21.4% of patients and their mean values were significantly higher in the patients than in the subjects affected by gastritis HP negative used as controls (p = 0.05). This datum was confirmed by Western blotting. The presence of HSP 70 antibodies in the sera of those patients may support the link between the protein and the development and persistence of chronic inflammation in the gastric mucosa.

Type 2 autoimmune hepatitis and hepatitis C viraemia.

We present 10 Italian patients with type 2b autoimmune hepatitis (anti-LKMI positivity) and HCV infection. 6 patients had IgG concentrations above the upper limit of normal and all had histological features of chronic autoimmune hepatitis or chronic persistent hepatitis or cirrhosis. ANA and SMA were positive in 2 patients, pANCA in 3 patients. Anti-GOR were negative in all patients, 6 of them were HLA B8 DR3 and 2 HLA B8 DR4. Antibodies to HCV (tested by ELISA 2nd and 3rd generation) were positive in all patients and in 9 subjects were detected HCV RNA. The two patients with positivity for ANA and SMA were treated successfully with corticosteroids, but they relapsed after the drug withdrawal; the others received interferon, that had to be suspended in 2 patients because inducing an autoimmune thyroiditis. Although, at present, it is still not known if HCV is a really trigger factor in developing autoimmunity or if the two diseases are coincidental, the authors suggest that it is important for clinicians to use appropriate treatment strategies on the basis of the predominant illness.

Variability of immune response induced by bacteria treated with subminimal inhibitory concentrations of fosfomycin.

Experiments were conducted to explore the possibility that bacterial strains treated with subminimal inhibitory concentrations (sub-MICs) of fosfomycin might induce immune responses different from those induced by intact, untreated bacteria. A preliminary study was done with a strain of Salmonella wien. The immune response in rabbits immunized with bacteria that had been exposed to either the sub-MIC or the minimal inhibitory concentration (MIC) of fosfomycin was compared with that in rabbits immunized with S. wien not exposed to the drug. The titers of antibody to S. wien in rabbits immunized with abnormal, sub-MIC-treated bacteria were higher than those in rabbits immunized with either MIC-treated or untreated S. wien. This difference was seen not only with the total antigen of Salmonella but also with somatic (O) and flagellar (H) antigens.

Immunogenicity of a killed E. coli 0111:K58 vaccine administered orally to children.

A killed E. coli 0111:K58 vaccine was administered by the oral route to 16 children ranging from 3 months to 7 years of age. The antibody response was measured at different times after the vaccination through the titration of agglutinating antibodies in serum and in fecal extracts, and the detection of specific IgA immunoglobulins in the intestinal content. All vaccines developed antibody response detectable both inserum and in fecal samples. Coproantibodies tended to appear earlier and to attain higher titers than circulating antibodies; they were all least in part IgA immunoglobulins, since the content of specific IgA in the fecal extracts was proportional to the agglutinating titer.

[Oral immunization of human adult volunteers using a trivalent coli-vaccine]. / Immunizzazione per via orale di volontari umani adulti con un colivaccino trivalente

Oral vaccination of 19 human adult volunteers with a killed trivalent E. coli vaccine induced an antibody response detectable either in sera and feces. Production of specific IgA immunoglobulins in the intestine was also observed. Antibody titres reached the highest levels 5-10 days after vaccination and were still detectable in the majority of volunteers about 2 months later.

[Oral immunization of rabbits against enteropathogenic serotypes of E. coli. II. Production of circulating and fecal antibodies induced with monovalent and polyvalent vaccines]. / Immunizzazione per via orale nel coniglio verso sierotipi enteropatogeni di E.coli. II. Produzione di anticorpi circolanti e fecali indotta da vaccini monovalenti e polivalenti

Oral vaccination of rabbits with killed polivalent E. coli vaccines (enteropathogenic strains) induced the production of circulating and fecal antibodies to the large majority of serotypes present in the vaccines. The production of specific IgA immunoglobulins in the intestine was also detected. The titres were in general of the same height as those obtained when individual vaccines were administered singularly.