Alpha1-microglobulin as an early biomarker of sepsis-associated acute kidney injury: a prospective cohort study.

BACKGROUND: Sepsis emerges as the leading risk factor for acute kidney injury (AKI) development in critically ill patients. Much effort has been invested so far on early diagnosis of AKI using promising biomarkers. This study aimed to determine whether urine alpha1-microglobulin (α1m), a lipocaline member previously used as an indicator of proximal tubular dysfunction, can early predict the development of sepsis-associated AKI (SAAKI) in critically ill patients. METHODS: A prospective, observational study was conducted in a single center Intensive Care Unit (ICU). Patients with normal renal function admitted to the ICU followed for sepsis and AKI development. Urine α1m levels were analyzed in pooled samples from 24-hour urine collections on sepsis onset and at various time points thereafter. The diagnostic performance of urine α1m was assessed using thenonparametriccalculation of the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. RESULTS: Among 286 critically ill patients admitted to our ICU in a year, 45 patients with sepsis met the inclusion criteria. SAAKI developed in 16 septic patients (35.6%). Urine α1m levels were significantly elevated in all septic patients (average value of all samples on the day of sepsis: 46.02 ± 7.17 mg/l) and showed a trend to increase in patients who finally developed SAAKI. The AUC for SAAKI prediction according to α1m urine levels 24-hours before SAAKI onset was 0.739 (sensitivity 87.5%, specificity 62.07%, cutoff level 47.9 mg/l). Urine α1m 24-hours before SAAKI, serum creatinine on sepsis onset and Acute Physiology and Chronic Health Evaluation II (APACHE II) score on sepsis onset emerged as the most powerful independent predictors of SAAKI. The combination of these three parameters improved the AUC for SAAKI prediction to 0.944. CONCLUSION: Urine α1m levels might help in the early prediction of SAAKI development and may prove useful biomarker. The pathogenetic implications of α1m in sepsis and SAAKI need further investigation. Hippokratia 2014; 18 (3): 262-268.

Hair nicotine/cotinine concentrations as a method of monitoring exposure to tobacco smoke among infants and adults.

In this pilot study, we examined the validity and usefulness of hair nicotine-cotinine evaluation as a biomarker of monitoring exposure to tobacco. Head hair samples were collected from 22 infants (<2 years of age) and 44 adults with different exposures to tobacco (through either active or passive smoking) and analyzed by liquid chromatography-mass spectrometry (LC-MS) for nicotine and cotinine. Hair samples were divided into three groups, infants, passive smoker adults and active smoker adults, and into eight subgroups according to the degree of exposure. The limit of quantification (LOQ) was 0.1 ng/mg for nicotine and 0.05 ng/mg for cotinine. Mean recovery was 69.15% for nicotine and 72.08% for cotinine. The within- and between-day precision for cotinine and nicotine was calculated at different concentrations. Moreover, hair nicotine and cotinine concentrations were highly correlated among adult active smokers (R (2) = 0.710, p < 0.001), among adult nonsmokers exposed to secondhand smoke (SHS; R (2) = 0.729, p < 0.001) and among infants (R (2) = 0.538, p = 0.01). Among the infants exposed to SHS from both parents the noted correlations were even stronger (R (2) = 0.835, p = 0.02). The above results identify the use of hair samples as an effective method for assessing exposure to tobacco, with a high association between nicotine and cotinine especially among infants heavily exposed to SHS.

Determination of dialkyl phosphates in human hair for the biomonitoring of exposure to organophosphate pesticides.

A new, simple, fast and sensitive method that enables the measurement of four dialkyl phosphates (DAPs) in human head hair is presented in the current study. The dialkyl phosphates, dimethyl phosphate (DMP), diethyl phosphate (DEP), diethyl thiophosphate (DETP) and diethyl dithiophosphate (DEDTP) are non-selective metabolites of the organophosphate pesticides (OPs). The extraction of DAPs from hair matrix was achieved by one step methanolic extraction. Head hair samples from general population and population occupationally exposed to OPs were analysed using gas chromatography-mass spectrometry (GC-MS) after derivatization with pentafluorobenzylbromide. The recovery of the target compounds was estimated at 84.3% for DMP, 116.1% for DEP, 109.0% for DETP and 91.5% for DEDTP. The limit of quantitation (LOQ) and detection (LOD) was 20 and 6 pg/mg for DMP, 10 and 5 pg/mg for DEP and DETP and 5 and 3 pg/mg for DEDTP, respectively. With-run and between-run precision as well as accuracy was estimated. The percentage of positive hair samples for DMP, DEP, DETP and DEDTP for the group of general population was 63.0%, 96.3%, 66.7%, and 70.4% respectively. The samples from the group with occupational exposure were positive for all dialkyl phosphates analysed. The median concentrations for DMP were 165.0 and 181.7 pg/mg, for DEP were 51.2 and 812.9 pg/mg, for DETP were 54.0 and 660.1 pg/mg, and for DEDTP were 40.0 and 60.6 pg/mg for the general population group and the group with occupational exposure respectively. Significant differences in the levels of the total dialkyl phosphates amongst exposed and not exposed groups were observed (p<0.001). More specifically, the total ethyl phosphate (DEPs) and DAPs median concentrations were 119.5 and 301.5 pg/mg for the general population group and 1498.8 and 1694.4 pg/mg for the group with occupational exposure.

AIDS related information, attitudes and behaviours among Italian male young people.

In order to evaluate the AIDS related sources of information, knowledge, attitudes and behaviours among male young people it was filled in a multi-choice anonymous questionnaire by 2018 subjects, called for the first medical examination to Italian Navy and by 1348 recruits. The data from the latter group were used to make comparisons with our previous survey carried out in 1988. The most important sources of information on AIDS were mass media and school, on sexuality friends and family. AIDS awareness was greater among the high educated subjects and positively influenced by mass media and school as sources of information. In agreement with these data, knowledge was better about AIDS than about sexuality. Risk perception was positively influenced by the AIDS-related knowledge for called youth and a greater intolerance towards infected people was observed among the less educated and the less AIDS-aware subjects. On average 46% of the called up young men and 74% of recruits declared to be sexually active: among these, the mean age at the first sexual intercourse was 16, over 60% declared to have had multiple partners, over 30% unknown partners and over 30% didn't use condoms; 20% of called up and 38% of recruits indicated 2 or 3 risk behaviours. Factors determining sex-related risks were different according to the behaviour and the considered group. These results suggest that it is important for young people to be well informed about sex and AIDS before the beginning of sexual activity, if possible during compulsory school.

Year of birth, sex and residence, as "determinants" of tetanus incidence and immunity in Italy.

Regional results of a seroepidemiological study and official notification data are evaluated to describe the situation of tetanus in Italy. Tetanus incidence has been decreasing during the past years. Vaccination has been the principal means of tetanus prevention. Trend analyses for sex- and age-specific rates suggest a change of exposure, presumably linked to the transformation of the Italian society after the World War II, a higher incidence among the elderly as a function of poor coverage and vanishing immunity. Regional data show remarkable variability in prevalence of susceptible population. Reported rates by region are different. Different degrees of regional underreporting in case notification is suggested.

Prevalence of hyperimmunization against tetanus in a national sample of 18-26 year old immune subjects in Italy.

Prevalence of tetanus hyperimmunization was estimated among 3217 immune subjects to be approximately equal to 11%. Hyperimmunization was associated with age, area of residence and health care availability. Indiscriminate administration of booster doses of tetanus vaccine could result in some areas in unnecessary revaccinations and possibly hypersensitivity reactions. The immunization policy regarding booster doses should be based on factual evidence and not on rigid recommendations.

Immunity to tetanus among Italians born between 1956 and 1963.

Systematic mandatory immunization of children against tetanus begun in Italy in 1968. Preceding birth cohorts, accounting for almost 80% of present Italian population, were poorly immune or totally non-immune; around 90% of cases of tetanus occurring in Italy in recent years are observed among them. In a national sample of 4770 young males born between 1956 and 1963, about one third was not protected. Prevalence of non-immune subjects was greater in the Southern Regions and the Islands, in rural areas, among the unemployed, among the older birth cohorts.

A note on prevalence of anti-delta antibodies in a sample of 5005 healthy individuals.

Most studies on anti-delta, were conducted in patients with chronic liver disease or in chronic carriers. We determined by RIA Anti-delta antibodies in a sample of 5005 healthy young subjects from all regions of Italy. Estimated prevalence rate of anti-delta was around one per thousand.

[An original method of reversible surgical sterilization of women: salpingodeviation]. / Un metodo originale di sterilizzazione chirurgica reversibile femminile: la salpingodeviazione.

PIP: An original method for the surgical sterilziation of women is suggested and described. The sterilization is reversible in that the uterine tube is not removed but simply functionally excluded by means of a so-called uterine tube bypass. The operation is interesting technically but also for its potential social, judicial, and moral significance in connection with surgical sterilziation. (author's modified)^ieng

[Diagnostic and therapeutic use of dexamethasone suppression in some cases of hirsutism with elevated plasma testosterone (author's transl)]. / Impiego diagnostico e terapeutico della soppressione al desametasone in alcuni casi di irsutismo con testosteronemia elevata.

A group of 11 hirsute women with elevated total plasma testosterone (no ovaric neoplasia detectable) was studied by dexamethasone suppression test. Suppression to within normal limits was in 5 patients by dexamethasone alone. After a 5 month continuous therapy ovulation was restored and hirsutism reduced. Suppression was obtained in the other 6 patients only with estroprogestins. These results suggest an interesting hypothesis: hypertestosteronemias related to anovulation might be divided in two classes, the first one in which testosterone is synthetized from adrenal prehormones, the second one in which testosterone is synthetized from acetate.

[Clinical and hematogenic considerations on 2 cases of cerebral venous thrombosis occuring during the use of oral estro-progestational preparations]. / Considerazioni cliniche ed emogeniche su due casi di trombosi venosa cerebrale intervenuta durante l'uso di preparati estro-progestinici orali.

The authors illustrate the clinical peculiarities and the laboratory data of thrombotic accidents as complications of oral contraceptives and other estrogen-containing drugs, concerning modern literature. Moreover, they describe two cases of cerebral venous thrombosis verified in Neuropathology Department of Maria Vittoria Hospital-Torino. The problem of prevention of these accidents is debated in the second part of the article.

PIP: 2 cases of cerebral venous thrombosis in young patients on oral contraception are presented. Both patients were successfully treated. The authors review the recent literature on the subject, and list several important contraindications to the administration of estroprogestinic agents. In discussing the problem of prevention of thrombotic accidents, the authors refer to a series of laboratory tests useful in determining the quality and peculiarities of blood coagulation.

[Ovarian tumors (clinical cases)]. / Tumori rari dell'ovaio (casistica clinica).

The A. expose three cases of ovarian tumors: the first of a malignant teratoma with metastasis inside abdominal wall, the second of Brenner's tumor, the third of an estrogen-producing ovarian hypernefroma.