Search

The causal connection between serum biomarkers and COVID-19 severity or pathogenicity in children is unclear. The aim of this study was to describe clinical and immunological features of children affected by COVID-19. The secondary aim was to evaluate whether these cytokines could predict severity of COVID-19. All children (aged 0−18) admitted to the Pediatric Emergency Department and tested with nasopharyngeal swab for SARS-CoV-2 were recruited and assigned to three groups: COVID-19, other infections, control group. Clinical and laboratory data of these patients, including circulating cytokine levels, were analyzed in three groups. Fever was the most frequent symptom in COVID-19 (67.3%). Neutropenia was found in the COVID-19 group (p &lt, 0.05), no difference was observed for lymphocyte counts in the three groups. Higher levels of IL-6 and TNF-alpha were found in the COVID-19 group compared to other infections and control groups (p = 0.014 and p = 0.001, respectively). Whereas, in the COVID-19 group, no difference was observed as for the same cytokines among sub-groups of different disease severity (p = 0.7 and p = 0.8). Serum levels of IL-6 and TNF-alpha were higher in COVID-19 children than in children with other infectious diseases, but those levels did not correlate with disease severity. Clinical studies in a large pediatric population are necessary to better define the role of the immune-mediated response in SARS-CoV-2 infections in children.

Background Therapy for moderate to severe acute food protein-induced enterocolitis syndrome (FPIES) typically consists of intravenous fluids and corticosteroids (traditional therapy). Ondansetron has been suggested as an adjunctive treatment. We aimed to evaluate the efficacy of the parenteral (intravenous or intramuscular) ondansetron vs traditional therapy to resolve the symptoms of acute FPIES. Methods Cases of FPIES who had a positive oral food challenge (OFC) were retrospectively examined at two major hospitals over a two-year period (Rome, Italy; and Sydney, Australia). The efficacy of therapy, based on the percentage of cases who stopped vomiting, was compared in cases who received parenteral ondansetron and in cases who received traditional therapy or no pharmacological therapy. Results A total of 66 patients were included: 37 had parenteral ondansetron, 14 were treated with traditional therapy, and 15 did not receive any pharmacological therapy. Nineteen percentage of children treated with ondansetron continued vomiting after the administration of the therapy vs 93% of children who received traditional therapy (P

Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated gastrointestinal food allergic disorder. Some diagnostic criteria have been published for acute FPIES. Of course, they are not all the same, so the clinician must choose which ones to adopt for his/her clinical practice. We present here a brief review of these criteria and, through two clinical cases, show how the choice of one or the other can change the diagnostic destiny of a child with suspect FPIES.

Background Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE-mediated food allergy. In addition to the elimination diet regarding the culprit food, it has been proposed to avoid, for the 1st year of life, certain foods (legumes, cereals, poultry), which are considered at risk. This suggestion may not be appropriate in countries where the prevalence of multiple foods FPIES is low. We evaluated the usefulness of an oral food challenge (OFC) with a mixture of these “at risk” foods. Methods Children with acute FPIES younger than one year were enrolled. Skin prick tests (SPT) with commercial extracts and cooked foods were performed with legumes, cereals, poultry. All children performed an OFC with a mixture of these foods. After 3 months, the patients who passed OFC were contacted by telephone to verify the persistence of “at risk” foods tolerance at home. Results Fourteen children were enrolled, 13 with cow's milk FPIES and 1 with wheat FPIES. The SPT were always negative. All children passed the OFC and continued to eat “at risk” foods at home without adverse reactions. Conclusions To perform an OFC with a mixture of “at risk” foods for children with acute FPIES is a convenient and safe practice in countries where the prevalence of multiple foods FPIES is low. This procedure can avoid unnecessary elimination diet. This article is protected by copyright. All rights reserved.

Background Parenteral Nutrition (PN) is a technique of Artificial Nutrition used to feed patients who cannot or should not get their nutrition through eating. Preparation is complicated because it involves mixing, with aseptic technique, nutritional substrates with different chemical-physical features (water, glucose, amino acids, electrolytes, trace elements and vitamins) to obtain a sterile nutritional emulsion that must be stable during preparation, storage and administration. Purpose To check the stability of nutritional formulae for parenteral nutrition. Material and methods Six nutritional formulae were prepared, three variations for each, using three kinds of lipid emulsion. Also added: long chain triglycerides (LCT) emulsion from soybean oil and middle chain triglycerides (MCT) emulsion from coconut oil; enriched lipid emulsion (LCT + MCT) from soybean, olive, coconut and fish oils; omega-3 emulsion from refined fish oil. Each formula was prepared with different calcium concentrations, which, together with viscosity, is the critical parameter that affects Zeta potential and consequently stability. Analysis was performed using a helium-neon laser granulometer on diluted samples at time 0 and after 24, 48, 72 and 96 h in order to reproduce normal storage conditions and clinical use. Results The results of the analyses of lipid particles established different stabilities, depending on the different kind of lipids and concentration of calcium: nutritional formulae prepared with LCT + MCT have proved 96 h stability, independently of calcium concentration; nutritional formulae with enriched lipids and/or LCT/MCT and lipids from refined fish oil have been proved stable only if the calcium concentration is less than 9 mEq/litre. Conclusion The results suggest a 96 h shelf life from preparation for nutritional formulae prepared with LCT + MCT. Stability is maintained only if the calcium concentration is less than 9 mEq/litre in nutritional formulae prepared with enriched lipids or with the addition of LCT + MCT and fish oil. Reference 1. SINPE Guidelines for Hospital Artificial Nutrition 2002; RINPE Year 20, S5 : Update October 2003 Reference No conflict of interest.

Background/Aims: In the natural history of gastric cancer, non-invasive neoplasia (NiN) precedes invasive carcinoma. A histological classification of gastric NiN has recently been proposed by a World Health Organisation international panel of experts. Genetic instability is known to be among the molecular pathways involved in gastric oncogenesis. In this retrospective cross sectional study, microsatellite instability (MSI) was analysed in a consecutive series of NiN and NiN related histological alterations from a northern Italian region at high risk for gastric cancer. Patients/Methods: Fifty five consecutive cases (indefinite for NiN, 29 cases; low grade NiN, 17 cases; high grade NiN, nine cases) were analysed by radioactive polymerase chain reaction and electrophoresis for microsatellite alterations at six loci (BAT25, BAT26, D2S123, D5S346, D17S250, and D3S1317). MSI was defined according to the Bethesda criteria distinguishing: (1) no instability in the analysed loci; (2) low frequency MSI (MSI-L); and (3) high frequency MSI (MSI-H). Immunohistochemical expression of MLH1 and MSH2 proteins was also analysed in all cases. Results: Overall, MSI was found in 11 of 55 cases (indefinite for NiN, five of 29 (MSI-L, four; MSI-H, one); low grade NiN, three of 17 (MSI-L, one; MSI-H, two); high grade NiN, three of nine (MSI-L, one; MSI-H, two). Conclusions: In an Italian high risk area for gastric cancer, MSI is part of the spectrum of genetic alterations in gastric non-invasive neoplasia. In European populations at high risk of gastric cancer, DNA repair system alterations are thought to be among the early molecular events in gastric carcinogenesis.

A cohort study was conducted to evaluate the mortality pattern among female and male workers in a cigarette factory. The study followed 972 female workers and 761 male workers with at least 6 months of cumulative employment from 1 January 1962 through 1 July 1996. Among women, mortality from all causes of death [standardized mortality ratio (SMR) = 0.9; 95% confidence interval (CI) = 0.8-1.1] and mortality from all malignant neoplasms (SMR = 1.1; CI = 0.9-1.3) were consistent with reference rates. Male workers had a significantly reduced overall mortality (SMR = 0.8; CI = 0.7-0.9), while mortality from all malignant neoplasms was as expected (SMR = 0.9; CI = 0.7-1.0). Among female workers the frequencies of deaths from diseases of nervous system (SMR = 2.0; CI = 1.1-3.4) and from non-Hodgkin's lymphoma (NHL) (SMR = 2.7; CI = 1.0-5.6) were elevated at a statistically significant level. No association between duration of employment and diseases of nervous system was observed. A higher risk for NHL, based on three deaths, was reported among female workers with 15 or more years of employment (SMR = 8.1; CI = 2.2-21.0). Although based on small numbers, the excess of NHL here reported suggests that potential exposure to foliar residues of pesticides should be thoroughly considered in tobacco manufacturing.

The interdigestive gastroduodenal motor activity and serum motilin levels were studied in 22 dyspeptic patients with markedly delayed gastric emptying not due to diseases known to impair gastroduodenal motility and in 7 control subjects with normal gastric emptying. Motor activity was recorded using a manometric probe positioned in the gastric antrum and in the proximal duodenum, and blood samples for radioimmunoassay of motilin were taken every 15 min during the recording period. The control subjects showed gastroduodenal activity fronts of the migrating motor complex associated with motilin peaks. Almost all patients with delayed gastric emptying showed no activity fronts in the stomach, and only half of them showed activity fronts starting in the duodenum. In these patients a significant reduction in the number of motilin peaks and in the integrated motilin output during the identified peaks was also observed. The results of this study indicate that most dyspeptic patients with idiopathic delay in gastric emptying may also have an alteration in interdigestive gastroduodenal motility, mainly characterized by a lack of gastric activity fronts, associated with an impaired motilin release.

Sera from 46 patients with malignant melanoma (MM) in different clinical stages and from 25 healthy blood donors were studied by an indirect conventional immunofluorescent technique (IIT) and by an immunofluorescent complement-fixation test (ICFT). No specific and reliable serological reactivity could be demonstrated against autologous and homologous MM and other nonmalignant pigmented tissues. An increased incidence of diffused antinuclear (ANA; 41%) and cytoplasmic epidermal cell autoantibodies (A-CYT; 71%) was observed in the patients by IIT. Statistical evaluation of the results gave significant values in the χ2 test in patients for ANA (χ2 = 5.2061; p < 0.05) and for A-CYT (χ2 = 8.9176; p < 0.01) versus age-matched controls. Thyroid microsomal, gastric parietal cell, smooth muscle and mitochondria autoantibodies were, respectively, detected in 4.3, 4.3, 4.3 and 0% of patients’ sera.

We investigated ACTH and cortisol responses after ovine CRF injection (1 microgram/kg one bolus) in a group of 11 drug-free patients suffering from major depression. When compared to sex- and age-matched normal controls, our depressed patients showed: Higher ACTH basal values (p less than 0.002); higher cortisol basal values (p less than 0.009); blunted ACTH response to oCRF administration (p less than 0.23); higher cortisol response to oCRF (p less than 0.001). Our data show that in depressed patients the feed-back mechanism is functionally intact at the pituitary level on one hand, while on the other, a hyperresponsiveness of adrenal cortex (even to minimal stimuli) seems to be present. Moreover, a hypersecretion of endogenous CRF in these patients seems to be likely.

The interdigestive motor activity of the gastric remnant and the efferent jejunal loop was studied manometrically in 10 patients who underwent Billroth II operation for duodenal ulcer. Two groups, one of 9 normal subjects and the other of 7 duodenal ulcer patients, were used as controls. In the Billroth II group the interdigestive migrating motor complex (IMMC) showed a higher relative duration of phase II activity than the controls and a shorter mean time-interval than the controls between subsequent activity fronts, with abnormal jejunal propagation. These findings indicate that the distal two-thirds of the stomach are necessary for the inhibitory mechanism, which in normal conditions slow down the idiointestinal interdigestive motor activity to the level of that of the stomach, and suggest that some postgastrectomy syndromes, such as diarrhoea, may have their pathological basis in this hyperactive intestinal IMMC.

Antibodies to epidermal cytoplasmic antigens were detected by the indirect immunofluorescence (IF) technique in 36% of 100 adult healthy subjects and in 17.6% of 17 normal newborn infants. This type of autoantibody occurred in 33% of 100 cases with vitiligo, in 32.5% of 40 cases with psoriasis, in 55.3% of patients with malignant tumours and in 72.7% of subjects with malignant melanoma. The frequency of the autoimmune reactions was statistically significant only in patients with malignant neoplasms. In the majority of positive cases the IF pattern involved the upper layers of the epidermal cells (U-CYT). The basal layers was generally negative. Only a few cases showed a pattern involving both the upper and the basal layers (G-CYT). However, a wide variation in staining was noted when sera were tested on different skin specimens or different sections of the same skin. To identify the nature of the target antigen(s), absorption experiments of sera were attempted with lyophilized and particulate antigens. Animal and human blood cells and lyophilized homogenates of malignant tumours failed to absorb the autoimmune activity of positive sera. Only a powder preparation of keratin induced a decrease in antibody titres. It is postulated that they are the result of an antigenic stimulation by exogenous substances commonly present in the environment.

In 5 patients with partial gastric resection and esophagitis, in whom esophageal pH metry was unable to demonstrate significant gastroesophageal reflux (GER), we administered i.v. 5 mCi (185 MBq) of 99mTc-HIDA, the patient lying under a computer-assisted LFOV gamma camera. When gallbladder image was evident, caerulein was administered i.v. at a physiologic dose in order to induce gallbladder contraction, and in the subsequent 45 min the patient was asked to perform a standard series of manoeuvres that increase the intraabdominal pressure (Valsalva, etc.) and favour GER. Scintigraphic images and time/activity curves obtained from areas of interest corresponding to gastric remnant and distal esophagus showed that at least one of these manoeuvres in each case was followed by the appearance of the radiocompound in the distal esophagus, indicating a 99mTc-HIDA-tagged bile GER. Consequently, we believe that HIDA-GER dynamic scintigraphy may be more useful than esophageal pH metry in demonstrating the biliary origin of an esophagitis.

A method not needing fluoroscopic control for positioning a manometric probe in the gastroduodenal tract is described. It is based on hydrostatic pressure variations occurring at each recording port of a multichannel perfused probe after changes in patient's position. The data are fed into a computer and the schematic representation of the probe showing its position and direction appear on the CRT screen. The results were visually and mathematically compared with those obtained with fluoroscopy and showed good correspondence between the two techniques in identification of the position of the probe.

The interdigestive motor activity of the stomach and proximal jejunum was recorded with a manometric probe in 8 patients who underwent partial gastrectomy and gastrojejunostomy (Billroth II) for duodenal ulcer (PG group), in 9 normals (N group) and in 5 patients with duodenal ulcer (DU group). The latter two groups were considered as controls. In the PG group the motor activity was recorded from the gastric remnant and from the efferent loop, and the results were compared with recordings at similar levels in the other two groups. The probe catheters were perfused with bubble free water by using a low-compliance pneumo-hydraulic pump and were connected to transducers P 23 Db and a polygraph. The recording was carried out after 14 hours of fasting and lasted at least 180 minutes each.

Thirty-nine patients (14 non-diabetics, 8 chemical diabetics, and 17 overt diabetics) with circulating islet cell antibodies (ICA) were studied. Insulin and glucagon secretion after oral (100 g) and intravenous glucose loading (200 mg/kg bolus injection followed by an infusion of 20 mg/min over 60 min) and arginine infusion (25 g over 30 minutes) were evaluated in these patients and in non diabetic and diabetic ICA-negative controls. In the non-diabetic groups with or without ICA, insulin and glucagon responses to glucose were similar. Moreover, in ICA positive patients the response of these hormones to arginine infusion was reduced. Similar alterations in insulin and glucagon secretion were observed in the CIA positive and negative patients with chemical or overt diabetes. In particular, fasting hyperglucagonaemia and glucagon hyperresponse to arginine are associated with a lack of insulin secretion in the patients with overt diabetes. Hormonal differences between diabetics with and without ICA could not be detected.

The lymphocyte subpopulations of 26 insulin-dependent diabetics were studied. Thirteen of them had persistent pancreatic islet-cell serum antibodies (ICA) (mean (+/- SD) duration of diabetes 11 +/- 8 years). The others were ICA-negative (mean duration of diabetes 10 +/- 8 years). The mean fasting blood glucose in the week before the lymphocyte count was 1..37 +/- 0.45 g/l (two specimens for every patient). As controls 19 healthy volunteers, sex and age matched, were investigated. The T-lymphocyte count was no different in diabetics compared to controls. B-cells were significantly raised (p less than 0.01) in the ICA-positive group, when tested with anti-human gammaglobulin sera (IgG + IgA + IgM), anti-human IgM, while no difference was observed between ICA-negative patients and normal subjects. IgA-bearing lymphocytes were equally raised in both diabetic groups (p less than 0.05). These data show an altered immunological balance in type IB (autoimmune) diabetes, characterized by an increased number of B-lymphocytes.

A manometric study of the distal biliary tract was carried out by means of a side-hole perfused catheter passed through the papilla Vateri during duodenoscopy in patients with postcholecystectomy biliary pain not due to stones or inflammation of the biliary tree. The sphincter of Oddi showed in these cases a significantly higher basal tone than in controls with superimposed phasic pressure waves of high amplitude. The basal pressure of the common bile duct was also higher than in controls. These manometric findings may help differentiate the functional papillary stenosis from other causes of the postcholecystectomy pain syndrome and may be useful in settling the question of performing sphincterotomy in these patients.

To the Editor.— The association of vitiligo with a number of organspecific autoimmune disorders, such as pernicious anemia, 1 hyperthyroidism and hypothyroidism, 2 Addison disease, 3 and diabetes mellitus 4 is well known. An increased incidence of organ-specific antibodies was reported in patients with vitiligo, 5,6 but, more recently, no statistically significant incidence of autoantibodies was found in vitiligo patients. 7 One of the difficulties in accepting an autoimmune form of vitiligo has been the absence of circulating antimelanocyte antibodies; only Von Langhof et al 8 found an "antimelanin antibody" in serum samples from patients with vitiligo, but their report was not confirmed. 7 Antibodies against the cytoplasm of malignant melanoma cells have been found in cases of vitiligo associated with resolving halo nevus, but not in isolated vitiligo. 9 We here report our attempts to demonstrate a specific antimelanocyte antibody in sera of patients with vitiligo. Patients and Methods.—