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The genetic causes underlying epilepsy remain largely unknown, and the impact of available genetic data on the nosology of epilepsy is still limited. Thus, at present, classification of epileptic disorders should be mainly based on electroclinical features. Electro-clinical syndrome is a term used to identify a group of clinical entities showing a cluster of electro-clinical characteristics, with signs and symptoms that together define a distinctive, recognizable, clinical disorder. These often become the focus of treatment trials as well as of genetic, neuropsychological, and neuroimaging investigations. They are distinctive disorders identifiable on the basis of a typical age onset, specific EEG characteristics, seizure types, and often other features which, when taken together, permit a specific diagnosis which, in turn, often has implications for treatment, management, and prognosis. Each electro-clinical syndrome can be classified according to age at onset, cognitive and developmental antecedents and consequences, motor and sensory examinations, EEG features, provoking or triggering factors, and patterns of seizure occurrence with respect to sleep. Therefore, according to the age at onset, here we review the more frequently observed paediatric electro-clinical syndrome from their clinical-EEG, genetic and therapeutic point of views.

Skin and soft tissue infections (SSTIs) are a set of commonly observed pathologies which can present different features in terms of site and localization, clinical features, and the aetiological agent; their severity is related to the depth of the affected sites. The aim of this review is to summarize the recommendations of current guidelines concerning the management of SSTIs.

CHRONIC CARDIOVASCULAR AUTONOMIC ABNORMALITIES DURING BOTH SLEEP AND WAKEFULNESS HAVE BEEN DEMONSTRATED IN ADULTS WITH obstructive sleep apnea syndrome (OSAS), caused by sympathovagal balance alterations.1,–3 Persistent muscle sympathetic nerve activation and high levels of circulating norepinephrine increase the sympathetic drive in adults with OSAS.4, 5 At the same time, heart rate variability (HRV) during sleep is markedly reduced, which suggests impaired parasympathetic control.6 The pathogenesis of this persistent sympathetic activation has yet to be fully understood. Repetitive episodes of apnea cause hypoxia and sleep fragmentation, inducing tonic activation of chemoreflex activity, and an increase in sympathetic nerve activity, as, demonstrated by muscle sympathetic microneurography.7,–11 Studies in children with OSAS have reported increased blood pressure,12 changes in cardiac structure and function,13,14 increased fasting insulin and lipid levels,15,16 and endothelial dysfunction, as signs of cardiovascular damage.17,18 However, the few studies that have evaluated autonomic dysfunction reported an increase in diastolic blood pressure, both during wakefulness and sleep,19,20 as well as an increase in sympathetic activity, demonstrated by peripheral arterial tonometry,21,22 and catecholamine concentration measurements in plasma and urine.23 Yet other studies have documented an increase in HRV,24 and a drop in blood pressure during wakefulness, as assessed by the head-up tilt test, in children with OSAS.25 The head-up tilt test is part of the Ewing battery, which is a physiological test for the assessment of autonomic function.26 It studies cardiovascular autonomic reflexes by analyzing changes in heart rate and arterial pressure induced by a range of physiological stimuli. The aim of our study was to investigate the activity of the autonomic nervous system during wakefulness using the cardiovascular tests in a cohort of children with OSAS, in order to detect not only sympathetic, but also parasympathetic activity.

Ascertainment of SBIs plays a central role in their management, which can affect the prognosis, hopefully avoiding an inappropriate antibacterial therapy concerning choice, dosing, timing, duration and route of administration of antibiotics. Different aspects of SBI management were evaluated by interviewing doctors practising in ICU, Surgery and Haematology wards. In the period 16 June - 7 July 2003, 150 doctors, equally distributed by specialty and geographical location, experienced in the management of antibiotic therapy, were interviewed in order to acquire the following information: criteria adopted to define SBIs, presumed incidence, most frequent diagnosis, initial approach to antibiotic therapy (empirical or not, route of administration, mono- or combination therapy), ID consultation request. In most cases generic and empirical criteria are used to define SBI, generally associated to the presence of co-morbidities, the highest rates being reported in ICUs (35.1%) and Haematology (34.7%) wards. Pneumonia is the top reported SBI in all the wards, followed by sepsis in ICUs and Haematology, and by intrabdominal infections in Surgery. Antibiotic therapy is often empirical (~90%), often performed i.v. with antibiotics given in combination. Following treatment failure, which occurs on average in 35.5% of cases, ID consultation and microbiological investigation are required. ID consultation is required in 20.2%, 26.1% and 28.1% of cases by haematologists, surgeons and ICU specialists, respectively. SBIs frequently occur in all the wards where the interviews were conducted. Their management is generally empirical and either ID consultation or microbiological investigation is infrequently required especially as an initial approach. The use of appropriate guidelines and ID consultation, as proven in many controlled studies, could be efficacious in reducing the incidence of inappropriate therapies and increasing favourable outcome rates.

The Bactericidal Index is a new way to assess bactericidal activity, representing the total bacterial kill over a drug concentration range. The aim of the study was to compare the in vitro activity of LEV with that of CIP against uropathogens determined by MIC, MBC, time-kill curves and BI analysis. A total of 141 strains [E. coli (EC) n=30; Klebsiella spp n=30; P aeruginosa (PA) n=35; P. mirabilis (PM) n=21; E. cloacae n=25] were preliminarily tested for MIC evaluation. MICs were obtained by 100 l microbroth dilution, followed by whole volume transfer for MBC determination. The time-kill tests were determined with 3 isolates each of EC, PA and PM and the killing monitored over 24h. FQs were added to a final concentration of 0.25, 0.5, 1, 2, 4, 8 and 16xMIC. Aliquots were sub-cultured at intervals. To assess the BI, overnight bacterial cultures were diluted to about 107 CFU/ml and set up containing a range of drug concentrations. MIC values of LEV were slightly higher than CIP; MBC/MIC ratio was in the range 1:1/1:2. LEV showed 99.9% killing after 6h against EC and after 3 h against PA at 1xMIC and after 3h at 2xMIC against PM in contrast with CIP (after 3h at 8xMIC). The BI data showed that FQs became more bactericidal with increasing incubation time and evidenced the enhanced bactericidal potency of LEV. A paradoxical effect was observed for all PA and PM strains, with slower killing at high concentrations of LEV (128 g/ml) at 24h and CIP (4 g/ml) at 3h. CIP was more active in terms of MIC values but LEV exhibited similar or even better bactericidal activity when time-kill curves or BI were compared. Calculation of BI allows the bactericidal activity of drugs, at clinically relevant concentrations, to be readily compared.

The aim of the study was to evaluate the incidence of post-surgical infections and to assess the way of managing antibiotic surgical prophylaxis. The survey was carried out by means of a questionnaire in order to obtain diverse information such as demographics, length of pre- and post-operative hospitalization, type of surgery, intervention duration, possible antibiotic prophylaxis and onset of post-surgical infections also monitored by post-discharge ambulatory controls. Four General Surgery and five Obstetrics and Gynaecology Departments in Campania (southern Italy) participated in the study, which was carried out in the period December 2001-January 2002. Overall, 410 questionnaires were collected referring to as many patients; antibiotic prophylaxis was performed in 385 (93.9%) patients. Antibiotic prophylaxis was generally managed not according to the general principles suggested by the international guidelines either for timing or for its duration or for the route of administration. Substantial differences were also noted in patient selection and antibiotic choice. Surgical site infections were recorded in 0.6% of patients undergoing clean surgery, in 5.3% of patients undergoing clean-contaminated surgery and in 3.2% of those undergoing contaminated surgery. Distant infections occurred in 1.8% and 6.5% in clean-contaminated and contaminated surgery, respectively. The results of the present study suggest the need of a continuous and accurate monitoring of post-surgical infections and the need to adopt appropriate guidelines to improve the management of surgical prophylaxis.

In the early eighties, in the US the advantages (reduced costs, no hospitalisation trauma in children, no immobilization syndrome in elderly, reduction of nosocomial and acquired infections by multi-resistant organisms) of OPAT were identified and suitable therapeutic programs were established. Following the US experience, other countries set up their own OPAT programs which vary considerably from country to country because of different ways in which infections are managed in different parts of the world and because of different reimbursement systems. In order to understand the ways of managing OPAT and its results, a National OPAT Registry was set up in 1999 in Italy belonging to a wider International OPAT database, which collects data also from USA, Canada, Spain, Uruguay and Argentina. Up to now 396 patients and as many antibiotic courses have been included in the National Registry by eight different centres. The analysis of data permits to get information about the criteria of patient's selection, treatment (route of administration, site of care, choice of antibiotic, dosage and duration), outcomes and possible side-effects. Italian results offer a quite peculiar picture of OPAT in this country when comparing data with those of other countries. In contrast with other countries where soft tissue infections and osteomyelitis are the most frequent diagnoses for including patients in OPAT programmes, in Italy pneumonia and bronchitis are the top two amenable infections. Ceftriaxone, Teicoplanin and Amikacin are absolutely the top three antibiotics selected for OPAT in Italy which confirm that a single daily dose regimen represents a great advantage in terms of compliance. Finally, a large percentage of antibiotic courses (50%) are carried out by using the i.m. administration route, which is very unusual in other countries. OPAT Registry is still ongoing and it will give us more detailed information in the future about the management of infections in the outpatient setting, but it already permits to define an actual picture of OPAT in our country and/or to compare and correlate data and information from different countries.

Introduction. Metabolic syndrome (MetS) definition is based on either abnormal values, or ongoing therapy demonstrating history of exposure to risk factors. This classification implies that therapy does not modify the MetS status, whereas therapy-modified components might modify attribution to, and prognosis of MetS. We tested the hypothesis that definition of MetS based on history rather than on direct evidence of abnormal risk factors is associated with a more benign cardiovascular (CV) phenotype. Methods. We studied 1642 African-American (1045 women) and 1289 Caucasian (681 women) HyperGEN participants, without prevalent CV disease or renal failure (serum creatinine >2.5mg/dL). MetS was defined by ATPIII, using cut-offs of blood tests, waist girth and measured blood pressure (BP), irrespective of on-going therapy (M1). M1 was compared with a subgroup of participants classified as MetS, based on history of exposure and on-going therapy to normalize risk factors (M2). We used LV mass index (LVMi), relative wall thickness (RWT) and a the ratio of stroke volume to pulse pressure (SV/PP) adjusted by heart rate, body weight and age (prognostically validated as a raw estimate of arterial compliance), as measures of end-organ damage. Results. Among 1102 participants with MetS (38%), 780 were confirmed by M1, whereas 322 (15%) had MetS by M2; 1892 were free of MetS by both criteria (no-MetS). Among M2 participants, 67% had normal fasting glucose, 71% normal triglycerides, 32% normal HDL-cholesterol, 16% normal waist girth and only 4% had normal BP. After adjusting for age, sex and ethnicity, mean LVMi was higher with in M1 (41.9 g/m 2.7) than in M2 (39.9 g/m 2.7) or no-Mets participants (37.6g/m2.7; all p