Volume 13, Issue 1, 2005
Review
Pulmonary hypertension and HIV: implementation of a Regional Registry
Petrosillo Nicola,
Chinello Pierangelo,
Vizza Dario,
Cicalini Stefania
In the era of new, potent antiretroviral therapy, much more attention is being given to non-infectious complications of HIV diseases, such as cardiomyopathy, pericardial effusion and pulmonary hypertension (PH). PH diagnosis is based on a mean pulmonary artery pressure of more than 25 mmHg at rest, or more than 30 mmHg with exercise. The incidence of PH is about 0.1% per year among HIV-positive patients, while in the general population it is 1 to 2 cases per million people. The histopathology of HIV-associated PH (HAPH) is similar to that of idiopathic PH, although its pathogenesis is still unclear. In patients with HAPH secondary causes of PH must be ruled out, such as intravenous drug abuse, valvulopathy, congenital heart disease and previous tricuspid endocarditis. The treatment of HAPH is not substantially different from that of idiopathic PH and is essentially based on the use of vasodilators. The Regional Authority of Lazio (Italy) has instituted a Registry for PH in HIV-positive patients; its aims are to evaluate the real incidence and prevalence of primitive and secondary PH among patients with HIV infection, and optimise the management of patients with suspected PH through the definition of a diagnostic algorithm.
Original article
An attempt to improve classification of HCV-correlated chronic hepatitis
Pasquale Giuseppe,
Sagnelli Evangelista,
Coppola Nicola,
Onofrio Mirella,
Scarano Ferdinando,
Scolastico Carlo,
Bellomo Patrizia Franca,
Lettieri Annamaria,
Mogavero Anna Rita,
Caprio Nunzio,
Sagnelli Caterina,
Piccinino Felice
To verify the clinical efficacy of the Desmet classification of chronic hepatitis C we reviewed 801 liver biopsies from patients with HCV-chronic hepatitis (CH). The diagnosis of chronic hepatitis was assessed according to the Desmet classification based on the Knodell Histological Activity Index (HAI) (minimal CH=score 1-3; mild CH= 4-8; moderate CH= 9-12; severe CH= 13-18). Liver fibrosis was assessed according to the Scheuer scoring system.
One hundred forty-eight patients had cirrhosis and 653 CH. Of these 653, according to the Desmet classification 145 patients showed minimal, 424 mild, 73 moderate and 11 severe chronic hepatitis. Since the classification underestimated the moderate and severe forms of HCV-related chronic hepatitis, we evaluated the possibility of improving the Desmet classification of chronic hepatitis C using our classification: minimal CH= score 1-3; mild CH= 4-6; moderate CH= 7-8; severe CH= 9-18.
According to our classification 145 showed minimal CH, 363 mild CH, 61 moderate CH and 84 severe CH. All the 61 patients who crossed over from mild CH under the Desmet to moderate CH under our classification showed a periportal inflammation of grade 3, and all the 73 patients but 8 who crossed over from moderate to severe showed a grade of periportal inflammation higher than 3. The Desmet classification of HCV-related chronic hepatitis underestimated the severe forms of HCV-CH, while our classification seems to be suitable also for chronic hepatitis C.
Alterations of bone metabolism in patients with chronic C virus hepatitis
Luchi Sauro,
Fiorini Italbo,
Meini Micaela,
Scasso Antonio
Patients affected with chronic hepatitis are prone to alterations in bone metabolism, osteoporosis and osteopoenia being the most common manifestations. Bone mineral densitometry is the method of choice for assessing bone mass; nevertheless, this is a static parameter whereas biochemical markers of bone remodelling reveal the dynamics of bone resorption and formation.
With this study we used bone mineral densitometry and biochemical markers to evaluate bone metabolism in a group of male patients with chronic C virus hepatitis and in a group of healthy males. In the hepatitis group 56% of the patients proved osteopoenic or osteoporotic and bone depletion increased as the histological score of the disease increased. Crosslaps are a parameter of osteoclastic activity: their measurement showed alterations in all the age groups of the hepatitis patients studied, which goes to show that there is intense bone remodelling in these individuals due mainly to osteoclastic resorption. Hepatitis C is a risk factor for bone depletion: we believe that when this type of hepatitis is diagnosed it is useful to assess bone metabolism with bone mineral densitometry and with the crosslaps assay.
Clinical and laboratory features of acute rheumatic fever: a 18-year experience
Minola Eliseo,
Arosio Marco,
Rizzo Giovanna,
Passerini Tosi Cristiana,
Suter Fredy,
Goglio Antonio
In the present paper we present the retrospective analysis of clinical manifestations and laboratory findings observed in 30 patients (M/F 13/17; age range 9-66 yrs) affected by acute rheumatic fever observed within the Infectious Disease Department along a period of 18 years (1986-2004). Diagnosis of carditis was stated on clinical and echocardiographical bases and occurred in 50% of patients. Such patients presented mild to moderate heart disease (30%) and severe carditis (20%). Therefore, our data stand to confirm that rheumatic cardiac disease could determine permanent and/or severe heart damage. All patients were observed during a 48-month period of follow-up without exitus.
Evolution in the hospitalization for infectious diseases among non-EU patients in Emilia Romagna
Sabbatani Sergio,
Passini Alessia,
Ravioli Valentina,
Chiodo Francesco
In the Emilia Romagna (ER) area, between 1996 and 2000, a progressive increment in hospitalization for TBC, malaria, AIDS and hepatitis in non-EU patients was observed. This study aims to determine whether this trend was confirmed in 2001 and in which cities the increase was most significant. The Hospital Discharge Cards (HDC) registered in ER for non-EU patients in the relevant period were examined.
In 2001, of 20,980 hospitalization cases of non-EU patients, 394 (1.87%) were attributed to infectious diseases, amounting to an increase of 1.77% over 2000. Of the 394 patients 250 (63.45%) were male and 144 (36.55%) female. The most represented age group was 20-39 yrs. Male patients more frequently come from Morocco (54), Senegal (45), Brazil (43), females from Nigeria (36), Morocco (26) and Ghana (14). The towns and cities where hospitalization occurred were, in decreasing order: Modena (24.6%), Bologna (19.3%), Reggio Emilia (12.9%), Ravenna (10.4%), Rimini (8.6%), Parma (8.3%), Piacenza (7.3%), Forlì (4.8%), Ferrara and Cesena (both 1.8%).
The Hospital Departments primarily involved were: Infectious Diseases with 213 hospitalizations (54%), Pneumology 69 (17.5%), Medicine 44 (11.1%), and Paediatrics 39 (9.9 %). Hospitalization causes were, in order of frequency: TBC with 137 cases (34.8%), malaria 75 cases (19%), AIDS 72 cases (18.3%), viral hepatitis 56 cases (14.2%), septicaemia 22 cases (5.6%) and Salmonella spp. infections 18 cases (4.5%).
Case report
A case of right-side infective endocarditis with ventricular septal defect
Turhan Özge,
Saba Rabin,
Belgi Aytul,
Inan Dilara,
Karaoglan Hicran,
Yalcin Ata Nevzat
A 28-year-old woman previously known to have a ventricular septal defect presented with fever, headache, abdominal pain and nausea. Positive blood culture of methicillin-sensitive Staphylococcus aureus and the detection of vegetation attached to the right ventricular wall near the ostium of the ventricular septal defect confirmed diagnosis of infective endocarditis. After four weeks’ treatment with proper antibiotics the patient recovered.
HCV infection and pericarditis: an extrahepatic manifestation?
Bertuccio Salvatore Nicola,
Rombolà Ferdinando,
Bertuccio Antonia,
Salvatore Francesco
The authors describe a clinical case in which they found the unusual combination of acute hepatitis caused by HCV and pericarditis in a young person, resulting in complete recovery from the pericarditis but in a deterioration of the chronic HCV. A close examination of the literature on this subject revealed that, although no similar case was recorded, an aetiological relationship between the hepatitis C virus and pericarditis cannot be excluded since an HCV infection often gives rise to extra-hepatic cardiac problems.
Acute transverse myelitis and hepatitis C virus
Annunziata Pasquale,
Marroni Massimo,
Francisci Daniela,
Stagni Giuliano
In the last few years, substantial evidence has been provided on peripheral nervous involvement in infection by hepatitis C virus (HCV), whilst central nervous involvement is rare. Here, we report a case of acute transverse myelitis in a woman developing 4 years after documented HCV seropositivity, associated with intrathecal anti-HCV protein IgG. Isoelectrofocusing of all CSF samples before and after immunoabsorption with recombinant structural HCV proteins revealed disappearance or marked decrease of some oligoclonal IgG bands suggesting binding to HCV proteins. To our knowledge, this is the first report of acute myelitis associated with intrathecal immune response against HCV proteins. This finding suggests that in acute myelitis of unknown aetiology, testing CSF for HCV RNA and related antibodies is warranted.
The Infections in the History of Medicine
Tuberculosis in the 19th and 20th centuries: epidemiology and the role of urban health programmes in tuberculosis prevention in Bologna
Sabbatani Sergio
The author reports the scenario in which the bacteriological revolution arose and developed during the 19th century. In this period medical research improved its theoretical basis and clinical practice, and aimed at becoming an exact science. Scientific discoveries in the field of microbiology and growing social and sanitary awareness conferred a very particular specificity on tubercular disease: this pathology was defined a work-induced infectious disease, as L. Devoto stated at the beginning of the 20th century. After introductory statements, we present statistical and epidemiological research carried out in the 19th century among populations of workers, and studies that show the relationship between the diffusion of the tuberculosis epidemic and the high concentration of people in degraded urban areas. We also present statistics on tuberculosis mortality in the Kingdom of Italy, the region of Emilia Romagna, and in Bologna. Finally, we briefly describe the urban improvement measures performed in the Bologna area after the unification of Italy (1860), which allowed contagion to be reduced, as well as both the mortality and morbidity rate in this urban area.
