Roberto Antonucci

Hepatitis E in Italy: A silent presence

Hepatitis E virus (HEV) was discovered in the 1980s and has been considered as being confined to developing countries. The purpose of this critical review was to determine the reported HEV seroprevalence rates in Italy, to identify predisposing factors and individuals at risk and to assess possible importation of HEV by immigrants. A critical review of 159 articles published in PubMed from 1994 to date was done. Only 27 original reports of 50 or more subjects, written in the English or Italian language, were included. Over three decades, the HEV seroprevalence varied from 0.12% to 49%, with the highest rates being reported from the central region of Italy. Risk factors included ingestion of raw pork or potentially contaminated food. The seroprevalence among immigrants ranged from 15.3% to 19.7% in Apulia. Italy has a population of 60656000; the total number of individuals surveyed was only 21.882 (0.036%). A national epidemiological survey program is needed to capture more comprehensive seroprevalence data.

Intrahepatic bile duct primary cilia in biliary atresia: Primary cilia in biliary atresia

The etiopathogenesis of non‐syndromic biliary atresia (BA) is obscure. The primary aim was to investigate intrahepatic bile duct cilia (IHBC) in BA at diagnosis and its correlation with clinical outcome. The secondary aim was to analyze IHBC in routine paraffin‐embedded liver biopsies using conventional scanning electron microscopy (SEM).

Misleading presentation of staphylococcal pneumonia in an adolescent girl: a case report

S. aureus is a relatively uncommon causative agent of community-acquired pneumonia. The clinical presentation of staphylococcal community-acquired pneumonia is typically acute and severe. Rarely, its clinical and imaging features may mimic other lung diseases, thereby delaying and misleading the diagnosis. We report a case of a 13-year-old girl without predisposing factors who was admitted with a recent history of mild chest pain, weakness and slight fever. Although clinical presentation and imaging findings suggested tuberculosis infection, broncho-alveolar lavage results showed a positivity for methicillin-susceptible S. aureus . A complete recovery was observed after a 21-day course of antibiotics. Our case highlights that staphylococcal pneumonia may develop in adolescents without underlying risk factors, mimicking, in rare cases, clinical presentation and radiological features of pulmonary tuberculosis.

Postnatal Growth in a Cohort of Sardinian Intrauterine Growth-Restricted Infants

Recent studies have shown that infants with intrauterine growth restriction (IUGR) undergo catch-up growth during infancy. The aim of our study was to evaluate the postnatal growth in a cohort of IUGR infants born in a tertiary-level Obstetric University Hospital of Northern Sardinia. An observational retrospective study was conducted on 12 IUGR (group A) and 12 control infants (group B) by measuring the anthropometric parameters of weight (W), length (L) and head circumference (HC) from birth to the 3rd postnatal year. At birth, significant differences were found between group A and group B with regard to all the auxological parameters (W, mean 1846.6 versus 3170.8 g, p < 0.0001; HC, 30.1 versus 34.4 cm, p < 0.0001; L, mean 43.4 versus 49.4 cm, p < 0.0001). During the 1st year, 8 of 12 (70%) IUGR infants exhibited a significant catch-up growth in the 3 anthropometric parameters and a regular growth until the 3rd year of follow-up. The majority but not all infants born with IUGR in our series showed significant postnatal catch-up growth essentially during the first 12 months of life. An improved knowledge of the causes of IUGR will help to develop measures for its prevention and individualized treatment.

Autoantibodies against CYP-2C19: A Novel Serum Marker in Pediatric De Novo Autoimmune Hepatitis?

Diagnosis of de novo autoimmune hepatitis (AIH) after orthotopic liver transplantation (OLT) is challenging especially in the absence of hyper-γ-globulinemia. Circulating autoantibodies are not sensitive nor specific in de novo AIH but when positive increase the diagnostic probability. We report the discovery of novel liver microsomal (LM) autoantibodies against CYP-2C19 in a 9-year-old boy with “de novo” AIH developed 7 years after OLT. Graft dysfunction presented with hypertransaminasemia (up to 400 IU/L), while serum γ-globulins remained within the normal range for age. Liver histology and response to high dose prednisone (2 mg/kg/day) with the addition of azathioprine therapy further supported the diagnosis of de novo AIH. Autoantibodies investigation by indirect immunofluorescence (IF) on rodent tissues showed a novel staining pattern involving the pericentral liver zone and sparing the renal tissue. Human but not rat liver proteins immunoblotting allowed us to characterize the novel LM antibodies and to identify CYP-2C19 as human antigen. The finding offers insights into the controversial discussion about autoimmunity versus alloreactivity with regard to the pathogenesis of de novo AIH. Correct information on human versus rat tissue antigens tested by methods other than IF for antibodies detection may have significant implications for the correct diagnosis and management of patients followed up after OLT.

Pregnancy Outcome among Women with Beta-Thalassemia Major in North Sardinia

ular menses. Among those who became pregnant, conception was spontaneous in 7, all of whom had regular menses. Nine pregnancies were achieved following gonadotrophin-induced ovulation, while intrauterine insemination was performed in 3 cases. Two patients developed gestational The life expectancy and quality of life of patients with thalassemia has significantly increased over the last few years due to an improvement in the management of a transfusional approach and iron chelation therapy. Despite these advances, hypogonadotropic hypogonadism is still a common problem [1] that has been associated with increased fetal and maternal complications during pregnancy [2] . As only a few studies have described the evolution of pregnancy in subjects with beta-thalassemia major when managed according to the most recent recommendations [3–5] , the present study investigated the methods of conception and the mode of delivery as well as the course and outcome of pregnancy in a cohort of 46 patients in North Sardinia during the period between 2001 and 2017. All patients provided informed consent and the study was approved by the local ethics committee. As shown in Figure 1 , 19 pregnancies occurred in 15 women with thalassemia major. The mean age at the time of the first pregnancy was 33 years (range 28–38). Of these, 4 were being treated with deferasirox, 6 with deferoxamine, 2 with deferiprone, and 3 with deferoxamine plus deferiprone. Chelation therapy was discontinued in all pregnancies. Three patients had primary amenorrhea, 1 had secondary amenorrhea, and 1 had oligomenorrhea, while 10 patients had basically regReceived: August 17, 2017 Accepted after revision: August 20, 2017 Published online: October 10, 2017

Bronchiolitis: what the clinician should know

Bronchiolitis is an acute infection of the lower respiratory tract affecting infants and young children, with Respiratory Syncytial Virus (RSV) being the most common pathogen. Bronchiolitis is generally a mild disease, but may present with severe signs and symptoms requiring hospitalization. Risk factors including prematurity, bronchopulmonary dysplasia, immunodeficiency and congenital heart defects may predispose patients to develop a severe disease. The diagnosis should be based on clinical evaluation, without supportive radiographic and laboratory studies. Etiological diagnosis may be helpful to decrease the hospital transmission of virus and to avoid inappropriate use of antibiotics. The mainstay of therapy for bronchiolitis is supportive care, which should be directed at maintaining adequate oxygenation, ensuring a proper respiratory toilet, and meeting the requirements of fluids and nutrition. The use of nebulized hypertonic saline should be limited to hospitalized patients. Severe respiratory failure may require mechanical ventilatory support. Neither corticosteroids nor antibiotics offer consistent benefit in the treatment of bronchiolitis, and thus should not be used. A trial of a bronchodilator may be appropriate, but should be continued exclusively if a prompt favorable response occurs. Effective interventions to prevent the spread of RSV infection include hand washing or disinfection by caregivers and contact isolation. The use of palivizumab, a monoclonal antibody directed against RSV, is a safe prophylactic option, but should be restricted to children at high-risk for severe RSV disease, during the epidemic period. Current evidence suggests that early RSV bronchiolitis predisposes children to recurrent wheezing and asthma in the first decade of life. Proceedings of the 11 th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26 th -31 st , 2015 · From the womb to the adult Guest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)