[Trend of circulating eosinophils in healthy children and children suffering from infectious diseases. A retrospective study]. / Andamento degli eosinofili circolanti nel bambino sano e nel bambino affetto da malattia infettiva. Studio retrospettivo.

INTRODUCTION: Acute bacterial and viral infections are accompanied by a marked diminution in circulating eosinophils in the blood. This forms part of the host's physiological response to acute infection and was first studied in adults early this century. The aims of this study were to check whether eosinopenia during acute phlogosis is a phenomenon present in pediatric patients, and whether the trend is comparable to the experimental models reported; to describe the trend of circulating eosinophils in the remission process. METHODS: A retrospective study was performed in 34 children hospitalised in the Pediatric Hospital of AUSL 2-Lucca (Italy) for bacterial or viral infective diseases documented by cell culture or presumed diagnosed. Children with the following characteristics were excluded from the study: 1) blood samples collected for hemochrome analysis at times other than normal (7-8 a.m.); 2) cortisone treatment administered up to 5 days prior to blood sample and/or during hospitalisation; 3) positive personal anamnesis for manifest allergic diseases. On admittance (children during acute phase) and at the start of remission, an absolute count of circulating eosinophils was performed in these children using an automatic globule counter. Sixty-six children with non evident infective and/or inflammatory diseases were included in the study as a control group. This group was also selected in the same way as infective subjects. RESULTS: The mean number of circulating eosinophils was 288 (+/- 248) in the control group, 46 (+/- 58) in subjects at the acute phase of infective pathology and 252 (+/- 162) in infective patient during the remission phase. The difference between the two means was statistically significant. This characteristic falling and rising trend of circulating eosinophils was found in 33 of the 34 infective subjects examined. CONCLUSIONS: Eosinophil values found in control subjects are broadly in line with those reported in the literature. Eosinopenia during the course of acute infection and the early rise during remission represent a characteristic phenomenon indicating the body's "normal" response to a non-parasitic infection. Both eosinophil levels, namely in the control group (288/mm3) and in acute-phase subjects (46/mm3), should be regarded as "normal" provided they refer to the appropriate situation. The precocity and precision with which the eosinophil trend follows the phases of the infection underlines the value of the assay of these cells as a reliable parameter for monitoring acute infection. There are also indications that, in an inflammatory situation, the behaviour of circulating eosinophils may provide a practical clinical marker of the predominant lymphocyte pattern (Th1 or Th2), as well as the phase of phlogosis, active or remission.

[Pattern of circulating eosinophils in allergic children suffering from infectious disease]. / Andamento degli eosinofili circolanti nel bambino allergico affetto da malattia infettiva.

BACKGROUND AND AIM: Both bacterial and viral acute infections are accompanied by a typical fall in the number of circulating eosinophils followed, at remission, by a rapid return to starting values. The aim of this study was to check whether this typical pattern can be observed in atopical children. MATERIALS AND METHODS: A retrospective study was performed in a group of atopical subjects (mainly asthmatic) suffering from intercurrent infectious diseases (mainly bronchopneumonia); circulating eosinophils were assayed during the acute phase of disease and during remission. The control group consisted of 21 atopic children without signs or symptoms of infectious diseases. RESULTS: The mean number of circulating eosinophils was 412.6 +/- 199.8 in the control group of allergic children 25.1 +/- 39.7 in the group with acute infectious diseases and 241 +/- 137.5 in the group of children with infectious diseases during remission. The differences between the group of children with infectious diseases and that in remission were statistically significant. The typical pattern of the fall and rise of circulating eosinophils was observed in 9 out of 10 children with acute infections. The cut-off proposed as the discriminating factor between acute phase infection and subjects in remission or without infectious diseases was 100 eosinophils/mm3. CONCLUSIONS: During the course of infective pathologies in allergic subjects there is an abrupt and significant reduction in circulating eosinophils followed, during remission, by a return to levels comparable to those in controls. Eosinophil assay therefore appears to be a useful parameter to monitor acute infection in allergic subjects. In particular, increased eosinophil levels are an early indicator that the infection has been overcome and remission is in progress. The authors repropose the hypothesis that eosinophils play a double role that alternates between activating the allergic phlogosis and eliminating non-allergic phlogosis, depending on the cytokinic context in which this occurs.

[Screening for celiac disease in children attending secondary school around Lucca]. / Screening del morbo celiaco nei bambini delle scuole medie della Piana di Lucca.

UNLABELLED: A growing number of clinical and epidemiological data point to the fact that coeliac disease (CD) is a pauci- or asymptomatic occurrence, relatively more frequent than it was supposed in the past, manifested in atypical, silent and latent forms which are often undiagnosed or diagnosed only at a later age. The fact that resolutive treatment is now available means that CD is an ideal field for the application of a screening method. In this context the study by Catassi et al. (1994) is particularly important since it reported a prevalence of 0.38% of CD in healthy children in the Pesaro-Urbino area. AIM: The aim of this study was to verify the incidence of CD in a nonselected pediatric population in the province of Lucca, using the aforesaid screening method. METHOD: The eligible population consisted of 1585 students from 5 secondary schools around Lucca, aged between 10 and 15 years old, none of whom were known to be affected by CD. In the first phase of the study anti-gliadin-IgA (AGA-IgA) and IgG antibodies were assayed in capillary blood (collected at school) using Alfa-Gliatest (Eurospital); children with AGA-IgA, AGA-IgG over 7 and 15 U/ml respectively were considered positive. In the second phase children with positive results underwent a further assay of AGA-IgA, AGA-IgG, anti-endomysium antibodies (EMA) and total IgA in venous blood. Lastly, children positive for AGA-IgA and/or EMA, or those positive for AGA-IgG with IgA deficit underwent duodenal jejunal biopsy. RESULTS: 41 children were positive on screening (2.6% of the eligible population, 3.8% of subjects effectively tested). Of these, 39 were assayed for AGA (IgA and IgG), EMA and total IgA in peripheral blood, identifying 4 subjects positive for AGA-IgA and EMA. Of the 4 children selected in this way, only 2 underwent jejunal biopsy and both presented "duodenal mucosa with chronic phlogosis and subtotal villous atrophy". Two cases of CD were formally ascertained with a prevalence of 1 out of 793 (0.13%) of the eligible population and an estimated prevalence of 1 out of 546.5 (0.18%) of the subjects undergoing screening. The cost was approximately Lit. 23,000 per child screened and approximately Lit. 6,100,000 for each coeliac child diagnosed. COMMENTS AND CONCLUSIONS: The diagnostic iter proved efficacious and enabled 4 "high-risk" children to be selected. If the two subjects who did not undergo biopsy are also formally considered as coeliacs, the prevalence would be 1 out of 396 (0.25%) of the eligible subjects, namely 1 out of 273 (0.37%) of effectively tested subjects. This is a figure which is very similar to that reported by other studies. The 4 children identified here as strongly suspected of CD did not possess any anamnestic and/or objective elements which might have suggested "ex ante" a diagnosis of CD. If confirmed, these data provide concrete evidence of the need to perform mass screenings to identify CD. The economic convenience of this procedure depends on a careful analysis of the costs of the failure to diagnose CD.

[Assessment of lead blood levels in children living in Lucca (Italy) in 1993. The study was conducted as part of the project METOS, in accordance with the decree 496 of June 1982 which adopted the directive CEE No.77/312]. / Livelli ematici di piombo nei bambini della piana di lucca. Rilevazione del 1993. Studio svolto nell'ambito del progetto Metos, in attuazione al D.P.R. 496/giugno 1982 che recepisce la direttiva CEE n degrees 77/312.

OBJECTIVE: Lead poisoning is a major cause of environmental concern in all countries worldwide. Saturnism in children, especially if young and neglected, represents a peculiar phenomenon both in terms of the biology of growing subjects and the epidemiological nature of poisoning. In under five-year-olds, in addition to lead levels in the atmosphere, it is equally important to evaluate the presence of contaminated dust in the house, hand-to-mouth activities and the level of care provided by parents. It has been demonstrated that, in the presence of equivalent environmental lead levels, dust removal from the house and prevention of hand-to-mouth activities can successfully reduce lead blood levels (PbB) in children. AIM: The aim of this study was to evaluate the risk of chronic lead poisoning in children attending Local Health Unit 6 in Piana di Lucca and to assess the need for a possible health education campaign aimed at eliminating the specific pediatric risk for lead poisoning. MATERIALS AND METHODS: Assay of lead blood levels in 172 children from 0 to 14 years old consecutively attending the Emergency Ward at Campo di Marte Hospital in Lucca for reasons not relating to lead poisoning. RESULTS: Mean lead blood levels in children were 57.2 +/- 30.2 mg/l (mean 50 mg/l) without significant differences between the various age brackets (0-5, 6-10, 11-14 years old). Only one child presented pathological PbB levels (280 mg/l when first measured; 360 mg/l a few months later with normal values of erythrocytic Zn-protoporphyrin, 24-h urinary lead excretion and 24-h urinary delta-aminolevulinic acid). An epidemiological study is now being made of the causes. The general population within the same area presented mean PbB levels of 70.4 +/- 36.9 mg/l (mean 60 mg/l), measured in a total of 471 subjects (adults and children). DISCUSSION AND CONCLUSIONS: The PbB levels currently found in children resident in Lucca confirm a low-risk environmental situation. Preventive measures specifically aimed at children do not therefore appear to be justified at present.

Corpus luteum function during the early puerperium.

Progesterone and 17 beta-estradiol peripheral plasma levels have been determined during labor and after 1, 3, 6, 12, 24, 48, 72, 96, 120 and 144 h from delivery in a group of 7 women, whose corpus luteum had been removed at delivery and in a corresponding control group with intact corpus luteum. In both groups the results indicate a progressive fall of progesterone and 17 beta-estradiol, that is evident until 144 h for progesterone and 72 h from 17 beta-estradiol. The analysis of the two groups with the Student's t test has shown significantly lower levels in the group of women, whose corpus luteum had been removed, at the 6th h (p less than 0.01), 12th h (p less than 0.02) and 24th h (p less than 0.05) for progesterone and at 3rd h (p less than 0.01) and 6th (p less than 0.01) for 17 beta-estradiol. The significant difference for progesterone appearing later than for 17 beta-estradiol could be due to the fact that progesterone is also dismissed by the adipose tissue, where it is stored. A further statistical elaboration of the results, carried out by calculating the regression line and the transfer function, confirmed the different pattern in time of progesterone and 17 beta-estradiol plasma levels after delivery in the two groups of patients considered.