1,720,979 research outputs found
L'infezione tubercolare nel bambino: il contributo dei nuovi test immunologici
No full textNegli ultimi decenni si è verificato un incremento dei casi di tubercolosi anche in aree tradizionalmente ritenute a bassa prevalenza di malattia, in particolare tra i giovani adulti recentemente immigrati. Questo fattore rappresenta un rischio di maggiore diffusione dell’infezione tra i bambini. I soggetti in età pediatrica, in particolare quelli al di sotto dei 5 anni di età, rappresentano un gruppo ad alto rischio di sviluppare malattia se infettati dal M. tuberculosis; peraltro, la diagnosi in questo gruppo di età presenta notevoli difficoltà per l’aspecificità del quadro clinico-radiologico e la bassa resa dei test microbiologici. I bambini ed i ragazzi a rischio di infezione tubercolare latente devono essere pertanto precocemente individuati ed opportunamente trattati.Fino a pochi decenni orsono l’unico test disponibile per individuare i soggetti con infezione tubercolare latente era il test cutaneo tubercolinico (o test di Mantoux), che però presenta notevoli limiti, in particolare mostra scarsa sensibilità (nei pazienti immunodepressi) e scarsa specificità (nei soggetti vaccinati con BCG). Sono stati recentemente sviluppati test basati sul rilascio di interferon-gamma che hanno dimostrato di avere buona sensibilità ed elevata specificità anche nei grupi più a rischio. È prevedibile quindi che l’applicazione di questi nuovi diagnostici in ambito pediatrico possa contribuire ad una più accurata individuazione dei soggetti con infezione tubercolare contribuendo quindi a ridurre la diffusione della malattia nella popolazione generale
Prior tuberculin skin testing does not boost QuantiFERON-TB results in paediatric contacts
No full textRecently, interferon-gamma release assays (IGRA) for specific diagnosis of Mycobacterium tuberculosis infection have become available. In recent UK tuberculosis (TB) guidelines, it has been advised to screen for latent M. tuberculosis infection using the tuberculin skin test (TST), followed by IGRA if the TST is positive. Since TST can boost immune responses to tuberculin, the present authors evaluated whether TST administration affects the result of QuantiFERON-TB Gold in-tube (QFT-GIT), a whole blood-based IGRA. QFT-GIT was performed on the day of TST administration and the day of reading in 15 TST-negative subjects, 46 TST-positive subjects with recent or remote exposure to M. tuberculosis and five cured TB patients. No systematic boosting of QFT-GIT responses from negative to positive was observed. Only in a few TST-positive persons did TST enhance pre-existing QFT-GIT responses. Screening for latent Mycobacterium tuberculosis infection using tuberculin skin testing followed by interferon-gamma release assays on the day of reading is a reliable approach, as the specificity of QuantiFERON-TB Gold in-tube is not affected by prior tuberculin skin test administration
Cricoarytenoid arthritis as an early sign of juvenile chronic arthritis
No full textA 14-month-old girl developed chronic strider and dyspnoea. Four months later she presented arthritis, anterior uveitis and positive ANA. Juvenile chronic arthritis (JCA) was diagnosed. Laryngoscopy demonstrated the presence of cricoarytenoid arthritis (CA). The left vocal cord was adducted and immobile, while the right vocal cord had decreased mobility. Erythema and swelling of the arytenoid cartilage on both sides was seen. Steroid treatment resulted in the resolution of these symptoms and made airway control unnecessary. This case demonstrates that CA may be the first sign of JCA, preceding peripheral arthritis. CA should be considered in, every child with chronic stridor and laryngeal obstruction
Alternaria spores at different heights from the ground
No full textBackground: Alternaria tenuis (Alt) is one of the main allergens in pediatric age. In temperate climates, airborne Alt spores are detectable from May to November with peaks in late summer and autumn. Sensitized children display symptoms even in the absence of airborne Alt spores. Alt spore concentration, as well as pollen, is usually detected by fixed devices located on the roof of a building at a height of 10-20 m. The aim of the current study is to find out whether ground-level (50 cm) Alt spore concentrations are different from those at roof-top level, even during low-concentration periods. Methods: Alt samples were taken simultaneously using a Hirst fixed volumetric collector (FVC) placed on a 15 m-high roof and by a portable volumetric collector (PVC). Firstly, the results of FVC and PVC, both placed on the roof-top, were compared to verify the correlation coefficient of the two samplers. Subsequently, the PVC was placed 50 cm above the ground in a courtyard (30 samplings) and in private green areas (50 samplings). The results were compared by statistical analysis (Student's t-test or K-S test). Results: The values of the 20 samples taken jointly in summer time (FVC 195 +/- 134 spores/m(3); PVC = 134 +/- 131 spores/m(3)) showed a good correlation between the two samplers (r = 0.850; P < 0.01), with a correction factor equal to 1.177. 1. Thirty samples obtained in summer and winter when the PVC was positioned in an enclosed courtyard directly below the FVC showed no significant difference (PVC, 181 +/- 194 spores/m(3); FVC, 152 +/- 145 spores/m(3); P = 0.221). 2. Fifty samples taken by PVC placed in private green areas in a low-concentration period, showed significantly higher concentrations than by FVC: PVC, 531 +/- 925 spores/m(3); FVC, 25 +/- 51 spores/m(3) (K-S test: P < 0.0001). In particular, 33 samples taken in winter when Alt counts by FVC were <10 spores/m(3) still demonstrated highly significant differences: PVC, 398 +/- 961 spores/m(3); FVC, 2.0 +/- 2 spores/m(3) (K-S test: P < 0.0001). Conclusion: Our results lead to the conclusion that Alt spore concentration is significantly higher at ground level in the presence of vegetation, even when the spore concentration is very low (<10 spores/m(3)). These results further suggest that the individual's exposure to Alt, especially in the case of children, is underestimated by samples taken at roof-top level by FVC
Extraction of a rubber bullet from a bronchus after 1 year - Complete resolution of chronic pulmonary damage
No full textInhalation of a foreign body (FB) into the bronchial tree rarely occurs asymptomatically and, if leading to recurrent pneumonia, can be very difficult to diagnose, The present report deals with the case of a 10-year-old boy who had three episodes of pneumonia in the left lower lobe caused by the asymptomatic inhalation of a FB 12 months before. Standard thoracic CT, done during the third episode, revealed a slight reduction in the volume of the left lung with air bronchograms, multiple areas of bronchiectasis, and parenchymal consolidation of a segment of the lower lobe, Flexible fiberoptic bronchoscopy revealed a FB at the distal end of the left lower lobar bronchus, surrounded by granulation tissue and fully obstructing the anterior basal segmental bronchus. High-resolution CT (HRCT) images showed an inverted C-shaped image obstructing a bronchus. Removal of the FB was successful only with rigid bronchoscopy under total anesthesia, The FB was an air-pistol rubber bullet that the boy remembered playing with 12 months before. Two months after removal of the FB (ie, 14 months from its asymptomatic inhalation) and treatment with oral steroids, antibiotics, and respiratory physiotherapy, the patient recovered completely, and HRCT showed complete normalization of the lung. We conclude that, when the radiographic density of the FB is greater than the surrounding pulmonary parenchyma, HRCT can reveal the FB, and diagnostic flexible fiberoptic bronchosopy can be avoided
Efficacy of specific sublingual immunotherapy on quality of life in asthmatic children with house dust mite respiratory allergy: prospective, multicenter case-controls 36-month study
No full textRationale: Specific immunotherapy (SIT) is considered as the only causal treatment of respiratory allergies. It is also known that SIT could have a positive impact on Quality of Life (QOL) of the allergic patients. However the are few data evaluating the impact of SIT or symptomatic drug treatment only in children with allergic rhinitis and asthma induced by perennial allergens.
Study aim: To investigate the impact of sublingual SIT on Quality of Life and the clinical efficacy in paediatric patients with house dust mite (HDM) respiratory allergy (rhinitis and mild to moderate asthma) in comparison with pharmacological treatment only.
Patients and Methods: In a multicentre, prospective 36-month case-control study 76 consecutive paediatric patients with rhinoconjunctivitis
and asthma due to HDM (mean [SD] age 11(3); 50 male) were enrolled. A total of 41 patients (cases) started a SIT (SLITone, ALK-Abello’) one
vial daily for 12 months as an add-one therapy and 35 matched subjects treated with symptomatic drugs only the controlsgroup. All patients had a confirmed diagnosis of HDM induced respiratory allergy. QOL was evaluated at baseline, after 12, 24 and 36 months by the means of two validated specific questionnaires (EQ-5D, italian version) (PAQLQ(S), italian version) Clinical efficacy was evaluated with symptom and medication score at baseline and after 12 month (intention-to-treat analysis). A Visual Analogic Scale (VAS) was also used to evaluate the subjective health status at the same times. Results: PAQLQ score improved significantly (P = 0.02) after 12 (+14%), 24 (+21%) and 36 (+36%) months of the observation period in case group in comparison with control group. Significant improvement was observed in the symptom and activity domains (10%). PAQLQ score in controls was slight reduced at the end of the observation period in comparison with baseline (P = 0.6). VAS score improves significantly (P = 0.001) in cases but not in the control subjects. Conclusion: Our study confirms that in comparison with symptomatic drug treatment only, SIT improves significantlyQuality of Life and the clinical course of the disease in children with HDM allergic asthma
Once-daily intrapleural urokinase treatment of complicated parapneumonic effusion in pediatric patients
No full textIn this paper, we describe our experience in the treatment of childhood empyema using urokinase. Patients' ages ranged from 2 to 12 years. Urokinase (dosage: 3,100 IU/kg/day) was diluted in normal saline to produce 1000 IU/ml (maximum dosage 100,000 IU in 100 ml of normal saline). After 2 hours, the clamped catheters were released and connected to water-seal suction at a negative pressure of 10 cm H2O. Pleural irrigations were continued once a day until thoracostomy tube output decreased to less than 10 ml/day (urokinase treatment mean duration: 11.5 days). The complete resolution of the chest effusion was assessed on chest ultrasound scan and radiographs. None of the patients experienced any side effects due to urokinase. It would now seem reasonable to advocate small chest tube thoracostomy and intrapleural urokinase as first-line treatment of pleural empyema in children, with surgery indicated as a secondaryintervention
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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