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Preterm premature rupture of membranes (pPROM) is a significant issue in obstetric practice. One of the risk factors for pPROM are vaginal infections in the third trimester of pregnancy.We performed an observational study on 600 pregnant women, analyzing the lactobacillary grade (LBG) and the presence of any pathogenic bacteria and/or Candida at weeks 28 and 32 of pregnancy and recording any pPROM events at delivery. At week 28, in the case of vaginal infection, the patients were treated for 6 days with a topical association of metronidazole+clotrimazole.At week 28 of pregnancy 54.2% of women had vaginal infection (32.6% bacterial vaginitis, 33.8% candidiasis and 32.4% mixed infection) and/or abnormal vaginal microbiota (67.4% LBG 2a/2b, 32.6% LBG 3). The total number of pPROM was 8 out of 600 (1.3%). The treatment of vaginal infection at week 28 with the topical association of metronidazole+clotrimazole, led to both the eradication of vaginal infections and the restoration of the vaginal microbiota in 72% of the cases, bringing the level of risk of pPROM similar to that of women without vaginal infection at week 28. In addition, the results showed that women with vaginal infections and/or alteration of vaginal microbiota at week 32 of pregnancy had a higher prevalence of pPROM in comparison to the women without vaginal infection at week 32 (p0.001).This observational study showed the high prevalence of vaginal infections in the third trimester of pregnancy and its association with pPROM. Furthermore, data suggested the possible benefits of the topical treatment with metronidazole+clotrimazole in pregnancy to eradicate infections, restore the normal microbiota and reduce the risk of pPROM.

Fetal nucleated red blood cells (FNRBCs) circulate in the maternal blood throughout pregnancy. Even if the frequency of fetal cells in the maternal circulation remains to be ascertained, complications of pregnancy such as fetal cells aneuploidies, preeclampsia, abnormal Doppler of the uterine artery without symptoms of preeclampsia, fetal growth restriction and polyhydramnios are associated with an increased feto-maternal trafficking. Based on these observations, previous studies have suggested that determination of the fetal nucleated red blood cell count (FNRBCC) might be a useful non-invasive screening test, either alone or in combination with existing maternal tests, for the non-invasive assessment of aneuploidies, in particular Down syndrome (DS). In this paper we have evaluated the distribution of FNRBCC in a set of 18 normal pregnancies and 18 pregnancies with a trisomy 21-affected fetus, matching for gestational age, maternal age, and, when possible, fetal gender, in order to quantify the difference in the number of fetal cells between the two populations. Maternal blood was collected from each pregnant woman two to three weeks after amniocentesis after knowing the cytogenetic results. Correlation of FNRBCC with the gestational week and clinical status (affected vs. non affected) by multiple regression analysis provided significant results (p < 0.001). Adjusted values of FNRBCC were 48 +/- 10.2 in controls and 301 +/- 17.01 in DS cases, corresponding to a 6.27 fold increase. These retrospective results prompt a prospective evaluation of the use of FNRBCC for screening purposes.

Interleukin-1 is a cytokine with bone-resorbing activity which is claimed to play a role in the pathogenesis of osteoporosis and of post-oophorectomy bone loss. We measured plasma levels of interleukin-1 (IL-1) in 16 women who underwent hysterectomy and bilateral oophorectomy and in 12 women with hysterectomy alone before surgery and 7, 15, 30, 45 and 60 days after surgery. Only oophorectomized patients showed a significant increase of circulating interleukin-1 levels. This increase was significant only 30 days after surgery, whereas a rise at 7 days (P0.001) was observed for serum calcium and hydroxyproline/creatinine and calcium/creatinine ratios. These data do not indicate a definite role of IL-1 in promoting bone resorption in estrogen-deficient women in vivo.

The isolation and analysis of nucleated fetal cells (NFCs) from maternal blood may represent a new approach to noninvasive prenatal diagnosis. Although promising, these techniques require highly accurate separation of NFCs from nucleated cells of maternal origin; the two major problems limiting these techniques are the relative rarity of fetal cells in maternal blood and the need to establish their fetal origin. We now report a novel procedure that has allowed accurate separation of NFCs from maternal cells. The technique reported involves direct micromanipulator isolation of histochemically identified hemoglobin F-positive nucleated cells to obtain fetal nucleated red blood cells (FNRBCs) of high yield and purity. Using this technique, followed by cell-by-cell multicolor fluorescence in situ hybridization (FISH) analysis of purified FNRBCs, we were able to detect some of the most common human aneuploidies (including Down syndrome, Klinefelter syndrome, and trisomy 13) in 33 pregnant women referred for amniocentesis. The procedure used, which can be completed in

Currently, prenatal detection of Down syndrome and other most common aneuploidies relies on invasive procedures such as amniocentesis and villocentesis, and on non-invasive screening tests such as second trimester maternal serum screening (Triple test), and first trimester screening (ULTRA-screen). However, it well known that invasive techniques carry a small risk of fetal loss, while both Triple test and ULTRA-screen are not diagnostic, may miss from 15 - 40 % of cases of Down syndrome, in addition to having a 5 - 8 % rate of false-positives. We now report clear evidence that the number of fetal nucleated red blood cells (FNRBCs) in the maternal circulation is remarkably higher in pregnant women carrying aneuploid fetuses, especially in cases of Down syndrome. These results are in agreement with the findings of other investigators using different methods, and suggest that the number of FNRBCs present in the maternal blood sample could be used as additional marker, in concert with existing screening tests, to improve non-invasive detection of Down syndrome, and other most common aneuploidies.

An extensive vaccination program to be used in highly endemic areas is the main strategy against the spreading of hepatitis B. The purpose of this study was the evaluation of the immune response to the recombinant HB vaccine administered singly or at the same time as other compulsory vaccines anti-diphtheria, anti-tetanus and oral anti-polio. Evidence was found of the serological efficacy both of HB vaccine and compulsory vaccines with a percentage of seroconversion of 100%. However, the infants who received HB vaccine at birth and at the age of 1 month had titers of antiHBs higher than the infants who received HB vaccine at birth and at 3 months. No difference in antibody levels of compulsory vaccines was observed among the study groups and the controls who received only compulsory vaccines. Our results suggest that HB vaccination must be encouraged and pursued in all newborns.

To further investigate the relationship between oophorectomy (OF) and mineral bone loss, 15 women who underwent total hysterectomy and bilateral oophorectomy were studied for 12 months after surgery. Mineralometric and metabolic data were obtained before and after 3, 6, and 12 months. The women lost bone mineral content (measured by single photon absorptiometry) at the same rate they lost cortical and trabecular bone, suggesting that bone loss after OF is a generalized phenomenon. Our data also show that an increase in bone resorption takes place only in the first period after OF; the persistency of a negative bone balance up to 12 months, accompanied by a reduction of osteocalcin serum levels, may be dependent on a reduced bone formation, probably due to osteoblastic insufficiency.

In vitro activity of Cefotaxime, Ceftriaxone, Ceftazidime, Piperacillin and Netilmicin against 189 urinary isolates of Enterobacteriaceae, Pseudomonas and Enterococcus has been evaluated. To assess the minimal inhibitory concentrations (MIC), the broth dilution method and the Sensititre system were employed. No considerable differences were found between the two methods. Cefotaxime showed the highest activity against Enterobacteriaceae, the great majority of the isolates being susceptible to 1 microgram/ml or less. Piperacillin showed good activity against Enterococci. Ceftazidime resulted the most active against Pseudomonas.

Sepsis is increasingly common and is now emerging as a iatrogenic condition, though the increase relates to both hospital-acquired and community-acquired infections. The causes and modalities of sepsis are reviewed with particular emphasis on the invasive treatment now extensively employed in patients with severe concomitant pathologies and immune deficiencies. The changing aetiology of the various forms of sepsis is analysed. These days common opportunistic Gram negative bacilli such as Enterobacteriacea and Pseudomonas as well as Candida mycetes are the most frequent cause of sepsis. The diagnostic importance of blood culture analysis is emphasised.

Biochemical characteristics employed to identify tuberculous and non tuberculous mycobacteria were evaluated. Tests for detection of nitrate reductase, catalase, gamma-glutamyl-transferase, niacin assay and growth on TCH media (2-thiophene carboxylic-acid hydrazide) were regarded of discriminating value. These tests have been applied to identification of 78 clinical isolates of mycobacteria. All strains were identified as Mycobacterium tuberculosis, that suggest the infrequency of human infections from Mycobacterium bovis and mycobacteria other than tubercle bacilli in our geographic area. It is also outlined that the gamma-glutamyl-transferase test constitute a rapid and simple assay for discriminating Mycobacterium tuberculosis from other closely related mycobacteria.

The majority of the strains of S. wien isolated in Sicily were resistant to six different antibiotics, showing the same resistance pattern (ASKCTSu) observed in strains isolated in other provinces of Italy. After conjugation with E. coli K12, the transfer of the whole pattern or of various groups of resistances was observed, which suggests the presence of several co-existent R plasmids. The results obtained suggest that the various outbreaks occurred in Italy have the same origin. They can be correlated with the epidemic of S. wien with the same transferable pattern of antibiotic resistance, spread in France in recent years from Algiers.

The activity of 68 mycobacteria strains belonging to 21 different species has been studied on 8 different chromogenic substrates utilized for determining the gamma-GT and various aminopeptidases. The assay was carried out using a simple method (bacterial suspension in solution M/10 of substrate and reading the result after 24 and 48h of incubation according to the color change) and interesting data were obtained about gamma-GT. This enzyme was present in all the strains of M.tuberculosis and in all the strains of the rapid growth species, absent in the other species. Thus, gamma-GT research is taxonomically and diagnostically useful in mycobacteria.