The DREAM model's effectiveness in health promotion of AIDS patients in Africa.

This study evaluates the effectiveness of a holistic model for treating people living with AIDS in Africa; the model aims to improve knowledge about AIDS prevention and care, increase trust in the health centre, impact behaviour, and promote a high level of adherence to HAART. The study took place in the context of the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) programme in Mozambique, designed by the Community of Sant'Egidio to treat HIV patients in Africa. It provides patients with free anti-retroviral drugs, laboratory tests (including viral load), home care and nutritional support. This is a prospective study involving 531 patients over a 12-month period. The patients, predominantly poor and with a low level of education, demonstrated a good level of knowledge about AIDS (more than 90% know how it is transmitted) and trust in the treatment, with a relatively small percentage turning to traditional healers. Overall the patients had a low level of engaging in risky sexual behaviour and a very good level of adherence to HAART (69.5% of the 531 subjects had a pill count higher than 95%). The positive results of the programme's educational initiatives were confirmed with the patients' good clinical results.

Structural studies on Pax-8 Prd domain/DNA complex.

Pax-8 is a member of the Pax family of transcription factors and is essential in the development of thyroid follicular cells. Pax-8 has two DNA-binding domains: the paired domain and the homeo domain. In this study, a preliminary X-ray diffraction analysis of the mammalian Pax-8 paired domain in complex with the C-site of the thyroglobulin promoter was achieved. The Pax-8 paired domain was crystallized by the hanging-drop vapor-diffusion method in complex with both a blunt-ended 26 bp DNA fragment and with a sticky-ended 24 bp DNA fragment with two additional overhanging bases. Crystallization experiments make clear that the growth of transparent crystals with large dimensions and regular shape is particularly influenced by ionic strength. The crystals of Pax-8 complex with blunt-ended and sticky-ended DNA, diffracted synchrotron radiation to 6.0 and 8.0 A resolution and belongs both to the C centered monoclinic system with cell dimensions: a = 89.88 A, b = 80.05 A, c = 67.73 A, and beta = 124.3 degrees and a = 256.56, b = 69.07, c = 99.32 A, and beta = 98.1 degrees , respectively. Fluorescence experiments suggest that the crystalline disorder, deduced by the poor diffraction, can be attributed to the low homogeneity of the protein-DNA sample. The theoretical comparative model of the Pax-8 paired domain complexed with the C-site of the thyroglobulin promoter shows the probable presence of some specific protein-DNA interactions already observed in other Pax proteins and the important role of the cysteine residues of PAI subdomain in the redox control of the DNA recognition.

Ascorbate-independent electron transfer between cytochrome b561 and a 27 kDa ascorbate peroxidase of bean hypocotyls.

Cytochrome b561 (cyt b561) is a trans-membrane cytochrome probably ubiquitous in plant cells. In vitro, it is readily reduced by ascorbate or by juglonol, which in plasma membrane (PM) preparations from plant tissues is efficiently produced by a PM-associated NAD(P)H:quinone reductase activity. In bean hypocotyl PM, juglonol-reduced cyt b561 was not oxidized by hydrogen peroxide alone, but hydrogen peroxide led to complete oxidation of the cytochrome in the presence of a peroxidase found in apoplastic extracts of bean hypocotyls. This peroxidase active on cyt b561 was purified from the apoplastic extract and identified as an ascorbate peroxidase of the cytosolic type. The identification was based on several grounds, including the ascorbate peroxidase activity (albeit labile), the apparent molecular mass of the subunit of 27 kDa by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, the dimeric native structure, the typical spectral properties of a heme-containing peroxidase, and an N-terminal sequence strongly conserved with cytosolic ascorbate peroxidases of plants. Cyt b561 used in the experiments was purified from bean hypocotyl PM and juglonol was enzymatically produced by recombinant NAD(P)H:quinone reductase. It is shown that NADPH, NAD(P)H:quinone reductase, juglone, cyt b561, the peroxidase interacting with cyt b561, and H2O2, in this order, constitute an artificial electron transfer chain in which cyt b561 is indirectly reduced by NADPH and indirectly oxidized by H2O2.

Alloimmune neonatal neutropenia treated with rHuG-CSF.

Infants with alloimmune neonatal neutropenia (ANN) may be at risk of life-threatening infection. Various modalities of treatment have been attempted but with differing results. We describe a case treated with rHuG-CSF. The use of rHuG-CSF should be considered in children with ANN especially when associated with life-threatening infection.

[Computerized tomography of the thorax and abdomen. Cost-effectiveness]. / Tomografia Computerizzata del torace e dell'addome. Costi ed efficacia.

This work was aimed at investigating the cost-effectiveness of body CT, toward better equipment allocation in a given area. CT economics were calculated taking into account four main parameters: equipment, drugs, sanitary material and personnel. The biological cost in terms of radiation exposure was calculated on the effective dose. Quality was evaluated by comparing it with that of our standard examinations and on the basis of the diagnostic yield according to the index of radiological diagnoses by the American College of Radiology (ACR). The economic cost of chest CT was It. L. 257,240, that of abdominal CT was It. L. 365,000 and that of both regions It. L. 464,620. The effective dose was relatively high, i.e., 15.2 mSV for chest CT, 18.65 mSV in men and 27.46 mSV in women for abdominal CT and finally 27.38 mSV in men and 33.59 in women for chest-abdominal CT. The coded diagnoses were positive in approximately 60% of the cases examined consecutively; positivity was related to clinically relevant conditions in most of the cases. The economics and the biological cost of body CT exams were closely related to exam quality, whose standard was high. The high rate of positive findings and the clinical relevance of the condition make an indirect indicator of high quality and of accurate patients selection. To conclude, the allocation of CT equipment in a given area should be preceded by a careful cost-effectiveness analysis, considering optimized equipment use as related to local clinical needs.

[Gastromiro vs gastrografin vs prontobario CAT for computerized tomography. Multicenter study]. / Gastromiro vs gastrografin vs Prontobario TAC per Tomografia Computerizzata. Studio multicentrico.

The opacification of intestinal loops is mandatory, during CT examination of the abdomen, to prevent the gut from being mistaken for a pathological process or vice versa. The authors compared Gastrografin and Prontobarium-CT with a new, orally administrable, non-ionic contrast medium (Gastromiro) to investigate whether the non-ionic molecule presents any advantages over the other contrast media usually employed with CT. Five hundred ml of water solution/suspension at 11.1% (Gastromiro or Gastrografin) and 1.7% (Prontobarium-CT) were administered 20 minutes before examination to 818 consecutive patients. Different parameters were considered--i.e., patient tolerance as far as "taste and vomiting" were concerned, gut opacification, and any reaction which might have occurred to the patients within 24 hours after examination. The results, statistically analyzed, are the following: no significant difference in the quality of opacification of stomach, duodenum, and large bowel; significant difference in the quality of opacification of small bowel, where Gastromiro proved to have the highest contrast resolution; Gatromiro stimulated diarrhea significantly less than Gastrografin and Prontobarium-CT.

Oropharyngeal and esophageal function in scleroderma.

Fifty-one patients with systemic sclerosis (scleroderma) underwent videofluoroscopy during barium swallow to evaluate the incidence of oropharyngeal deglutition abnormalities and to correlate the radiologic patterns of esophageal motility abnormalities with patients' clinical features. Thirteen patients (26%) showed swallowing dysfunction, (e.g., oral leakage, retention, penetration, mild or moderate aspiration, and upper esophageal sphincter incoordination). These dysfunctions were more severe in patients with prominent esophageal dysmotility. Normal esophageal motility was not associated with swallowing alterations. Patients with an oropharyngeal disorder had a higher incidence of pulmonary disease. The clinical picture of the above-mentioned 13 patients was more severe, based on the duration of Raynaud's phenomenon and duration of skin sclerosis. Patients with primary Raynaud's phenomenon had no oral or esophageal abnormalities. The esophageal phase of swallowing was abnormal in 80% of the patients with scleroderma. Esophageal dysfunction, therefore, seems to be frequent in the early stages of the disease. However, patients with advanced or extensive disease may have normal esophageal function.

[Correlation between the radiologic study of deglutition and the clinical picture in systemic sclerosis (scleroderma)]. / Correlazione tra studio radiologico della deglutizione e quadro clinico nella sclerosi sistemica (sclerodermia).

Fifty-one patients with systemic sclerosis (scleroderma) were studied by means of videofluoroscopy in order to evaluate the abnormalities in the oropharyngeal and esophageal phases of deglutition and to correlate the radiological patterns with the clinical features of the disease. Thirteen patients (25.5%) exhibited swallowing disorders such as oral leakage, retention, penetration, mild or moderate aspiration and abnormal upper esophageal sphincter behavior. These dysfunctions were more evident in patients with esophageal motility abnormalities. A normal radiological pattern in the esophagus was not associated with swallowing alterations. Remarkably, patients with oral-pharyngeal disorders had a higher incidence of lung diseases. Forty-five patients (88%) exhibited disorders of the esophageal phase of deglutition, such as mild or severe motility abnormalities or hiatal hernia, gastro-esophageal reflux, reflux esophagitis, and stricture. Radiological findings in the esophagus can be abnormal in the early stages of the disease. On the other hand, the radiological pattern of esophageal motility can be occasionally negative in advanced or extensive disease. This indicates a discrepancy between clinical symptoms and radiological picture of the esophagus. The radiological examination of the oral-pharyngeal and esophageal phases of deglutition is important in patients with scleroderma in order to evaluate visceral involvement, motility disorders, and risk of aspiration. Such radiological information can be useful in preventing esophagitis and pulmonary complications.

[Dynamic radiologic study of deglutition in oro-pharyngeal-laryngeal neoplasms and results of their treatment]. / Studio radiologico dinamico della deglutizione nelle neoplasie oro-faringo-laringee ed esiti del loro trattamento.

Swallowing disorders due to oro-pharyngo-laryngeal cancer, or due to the consequences of surgical resection and radiotherapy, should be accurately evaluated to manage properly both nutritional therapy and dysphagia rehabilitation techniques. The site, size, and local spread of such tumors and, especially, the nature and extent of surgical resection and reconstruction, are important factors which are closely related to the functional disorders of deglutition. The aim of this paper is to demonstrate video-fluoroscopy capability to evaluate the incidence, type, and severity of such functional disorders. For this purpose we studied by means of dynamic radiology 23 patients with oral cancer and 33 patients with pharyngeal-laryngeal cancer, most of them after surgical and/or radiological treatment. Eighty-four per cent of the patients had swallowing disorders such as poor oral processing (25%), retention of the bolus in the pharynx (41%), penetration (41%) or aspiration (37%) of the bolus in the airway, dysmotility of upper esophageal sphincter (9%), and structural lesions (61%). The association of these functional disorders was closely related to the pathological background of each patient. In conclusion, a dynamic radiological study is recommended for both pre and postoperative evaluation of these patients, to choose the appropriate nutritional therapy and dysphagia rehabilitation technique.

[Dynamic radiologic study with video recording of the oral and pharyngeal stages of normal deglutition]. / Lo studio radiologico dinamico con videoregistrazione delle fasi orale e faringea della deglutizione normale.

The upsurge of interest in dynamic radiology of the oral pharyngeal phases of deglutition can be explained by: (a) the increased survival-rate in neuromuscular diseases; (b) the improved results in head and neck surgery and radiotherapy; (c) the awareness of the existence of a "silent" form of dysphagia. This paper is aimed at divulgating the radiological dynamic investigation of deglutition by videorecording, and at assessing the findings of a study on 119 consecutive non-dysphagic patients (55 males and 64 females; mean age 54 years) as a control group for future studies on dysphagic patients. Seventy-nine out of 119 subjects (66.4%) were found to be normal. Various abnormalities were observed in the remaining 40 (33.6%), such as barium penetration in the subepiglottic or supraglottic space (20 cases), dysmotility of the epiglottis (14 cases), transient and mild cricopharyngeal muscle dysfunction (17 cases), diverticula (6 cases). Further studies are needed to evaluate the true significance and implication of these findings in asymptomatic patients. Finally, a more widespread use of this method is hoped for, in order to establish its diagnostic and clinical efficacy.

[Early diagnosis of sepsis in the preterm neonate]. / Diagnosi precoce di sepsi nel neonato pretermine.

The usefulness of the neutrophil blood cell count, the ratio of band forms to total neutrophils, the platelet count, the quantitative determination of serum IgM, C-reactive protein, alpha-1-acid glycoprotein and haptoglobin for the early identification of the serious neonatal infections was evaluated in 70 preterm newborns: 15 with sepsis, 2 with serious infections, 53 without infections. None of these tests has proved sensitive and predictive enough to be used as a single measure. The combination of 2 or more of them had improve the sensitivity (76.4%) and the predictive value of negative test (91.6%). The authors suggest that the greatest potential value of the tests is to exclude infections, with a more than 90% probability, if they are negative.

Significance of diffuse granularity and nodularity of the esophageal mucosa at double-contrast radiography.

Out of 5000 consecutive double-contrast examinations of the esophagus, 50 cases presented a diffuse finely granular or nodular appearance of the mucosa. Endoscopy was subsequently performed in 38 cases and biopsy in the majority of these. In 23 of the 38 verified cases the diagnosis was reflux esophagitis. In the other 15 cases the diagnoses were: candidal esophagitis (4), leukoplakia (2), glycogenic acanthosis (1), and diffuse leiomyomatosis (1). A normal mucosa was demonstrated in 7 cases. Our study indicates that a radiologically granular or nodular appearance of the esophageal mucosa often indicates reflux esophagitis and less commonly identifies diffuse lesions of variable origin.

Small benign tumors of the esophagus: radiological diagnosis with double-contrast examination.

Benign tumors of the esophagus are rare. So far radiological examination has been useful in the diagnosis of fairly large benign tumors. In 4100 consecutive double-contrast studies we have found 22 incidental cases of protruded lesions of the esophagus with the appearance of submucosal tumor (8 cases) or polyp of the mucosa (14 cases). The lesions were small: 14 were less than 1 cm and 8 were between 1 and 3 cm. The histological data showed leiomyoma in the submucosal tumors and squamous papillomas in the polyps of the mucosa. A noteworthy feature is the unusual frequency of small squamous papillomas detected. The radiological diagnosis of benign tumors of the esophagus cannot be confined to large tumors in symptomatic patients but may include the accidental detection of small tumors. These call for histological verification and possibly endoscopic removal.

Reflux esophagitis: radiologic-endoscopic correlation in 39 symptomatic cases.

Thirty-nine consecutive patients with symptoms suggestive of reflux esophagitis underwent a double contrast upper gastrointestinal series and subsequently had endoscopy with biopsy. In a control group of 164 consecutive patients without symptoms of esophagitis a double contrast examination was done with the same method. We have found a significant increase of the diameter of the esophagus in its distal or cardiac segment (IDCE) in patients with esophagitis of Grades 1 and 2 when compared with the control group (p less than 0.001). Radiology was found to have correctly diagnosed 35 of the 39 cases (89.7%) and the majority of the patients had endoscopic signs of mild esophagitis.

Radiologic diagnosis of early gastric cancer by routine double-contrast examination.

In 4538 double-contrast examinations of the upper gastrointestinal tract, 8 early gastric cancers (EGCs) were prospectively diagnosed before endoscopy. Four others were false negative cases, but retrospective analysis led to identification of the lesion in 3. The rate of EGC in radiologically diagnosed and verified cancers was found to be 10.6%. Gastric polyp rarely corresponded to EGC, whereas gastric ulcer more frequently corresponded to an EGC. Five of 12 EGCs were multifocal, with 21 satellite foci of carcinoma, of which 3 were probably radiologically identifiable as varioliform erosions. Routine double-contrast study appears valuable for detecting EGC, but the rate of false negative cases indicates that integration of radiologic, endoscopic, and cytologic data as well as accurate histopathologic study of the surgical specimen are needed to diagnose and characterize early gastric carcinoma.

[Diagnostic accuracy of double contrast examination in the detection of gastric polyps (author's transl)]. / Misura della accuratezza diagnostica dell'esame radiologico a doppio contrasto nel riscontro dei polipi gastrici.

Gastric polyps have been found in 2.9% of 4322 consecutive routine double contrast examination of upper gastro-intestinal tract. In 559 patients, endoscopically verified, sensitivity of radiological test was 96% and specificity 96.3%. An agreement index (K-index) was evaluated in a sample of 84 cases. The index value was 0.9 among 2 different radiologists with a similar, high experience and 0.8 among 2 radiologists with different degree of experience in double contrast examination. Our results demonstrate the validity of the double contrast study of the stomach as preliminary to endoscopy.

[Routine double contrast examination of the stomach: results and considerations on personal experience (author's transl)]. / L'esame di routine a doppio contrasto dello stomaco: risultati e considerazioni di un'esperienza.

The results are presented on the double contrast investigation of the stomach performed during routine hospital activity. Purposes of the work are to evaluate the diagnostic accuracy of the method and to suggest the location of the diagnostic investigation. 602 consecutive patients were examined and 188 out of these underwent endoscopy. The diagnostic accuracy of the method was evaluated at gastroscopic control. Moreover the cost of the method was considered, in order to evaluate the possible routine application of the method in the hospitals.