Rates of antibiotic resistance/sensitivity in bacterial cultures of hidradenitis suppurativa patients.

BACKGROUND: Antibiotic (AB) treatment is one of the first steps in the management of hidradenitis suppurativa (HS). Bacteria, in HS patients, may play a double role, as triggering factors of inflammatory reactions and/or agents of infection. OBJECTIVES: The aims of this study are as follows: (i) to assess prevalence and AB resistance of bacterial growths in HS patients (ii) assessment of the clinical relevance of obtained data in guiding the selection of the most effective AB therapy. METHODS: Purulent material from 137 skin lesions of HS patients was collected with swabs. Bacterial flora and AB sensitivity were determined using microbiological cultures for aerobic and anaerobic bacteria. RESULTS: A total of 114 samples resulted positive for bacteria. Sample was collected from the axillae, groin and perianal areas. A total of 163 single bacterial growths were observed; 55% were Gram-positive and 44% were Gram-negative. Among them, 18.4% were anaerobic. The most frequent bacterial families included enterobacteriaceae (30.7%), Staphylococcus (25.2%) and Streptococcus (14.1%). The most frequent genus or species were proteus spp. (13.5%) and Escherichia coli (9.8%). The prevalence of AB resistance observed was clindamycin 65.7%, rifampicin 69.3%, penicillin 70.0%, ciprofloxacin 74%, tetracycline 84.7% and erythromycin 89.0%. A limitation of the study is represented the short culture period adopted which may have impaired the isolation of anaerobes. CONCLUSIONS: Bacterial growth in HS patients has shown a high level of resistance to ABs, including rifampicin, clindamycin and tetracyclines, cited as an empiric choice in HS therapeutic guidelines. A targeted and specific AB therapy, driven by microbiological evaluations with prolonged culture periods, seems more appropriate than empiric, generic, non-specific, therapeutic approaches. Current knowledge regarding HS bacterial AB resistance should be considered in the update of current therapeutic guidelines for HS.

Colistin-based Treatment of Multidrug-resistant Gram-negative Bacterial Pulmonary Infections After Lung Transplantation.

BACKGROUND: Lung transplantation (LT) is a viable option for a select group of patients with end-stage lung disease. However, infections are a major complication after LT, accounting for significant morbidity and mortality. Several germs may be responsible; multidrug-resistant Gram-negative (MDR-GN) bacteria are emerging. Colistin is widely used in the treatment of these infections and is administered by inhalation and/or parenterally. At our institution, in patients with tracheostomy, colistin is administered by direct instillation in the airway during bronchoscopy. We reviewed a series of patients who underwent LT complicated by postoperative MDR-GN bacterial pulmonary infection. METHODS: From January 2015 to May 2017, 26 lung transplants were performed. In the postoperative course, 14 (54%) developed MDR-GN bacterial infection; respiratory specimen culture, blood tests, and chest X-ray were considered. Colistin was the only antibiotic usable. Thirteen patients received intravenous (IV) colistin; in the subgroup of patients with tracheostomy, colistin was instilled directly in the airway, and 6 patients received inhaled colistin. RESULTS: Seven patients needed tracheostomy. Pseudomonas aeruginosa was the predominant infection (86%), with Acinetobacter baumanii seen in 2 cases (14%). An early clinical-laboratory response was observed in 9 patients (64%). White blood cell count and C-reactive protein values improved (P = .02 and P = .001, respectively). A significant reduction in bacterial load was observed on microbiologic bronchoalveolar lavage specimens. CONCLUSION: Colistin instilled directly in the airway did not show side effects. The combination of IV and inhaled/instilled colistin could be a useful treatment option for MDR-GN infections after LT.

Psychological follow-up care of neurofibromatosis type 2 patients and their relatives.

Neurofibromatosis type 2 (NF2) confronts patients and their relatives with the dual issue of a progressive disease and disability. Deafness creates a brutal rupture in the patients' course of life, and other disabilities often follow in addition, that further deteriorates their quality of life. Hearing rehabilitation, via a cochlear implant and auditory brainstem implant, attempts to reduce the feeling of isolation and suffering due to communication impairment. A NF2-specific quality of life questionnaire not only helps to evaluate the impact of the disease but it is also useful therapy proposals (treatment, auditory implants). This may contribute to improve the quality of care for patients and their families. Within the multidisciplinary NF2 team, the psychologist offers constant listening of patients, and their suffering at each stage of the disease, that takes into account the life context in which the disease occurs, thus playing a major role in the patient care offered.

Evaluation of the impact of hearing loss in adults: Validation of a quality of life questionnaire.

OBJECTIVES: The impact of hearing loss and of auditory rehabilitation (hearing aid, cochlear implant) on quality of life is a crucial issue. Commonly used questionnaires to assess quality of life in these patients (Nijmegen, APHAB, GBI) are time-consuming, difficult for patients to fill out, and show poor sensitivity to small improvements or deterioration. The objective of the present study was to validate a dedicated quality of life scale for hearing-impaired adults with or without auditory rehabilitation. MATERIAL AND METHODS: ERSA (Évaluation du Retentissement de la Surdité chez l'Adulte: Evaluation of the Impact of Hearing Loss in Adults) is a self-administered questionnaire. It is divided into 4 domains, each comprising 5 questions graded from 1 to 10. The questions are simple, and formulated so patients will answer according to how they feel at the actual time of the session. Test-retest reliability was measured in 38 patients. Internal coherence and validity against the APHAB questionnaire as gold standard and in relation to hearing performance were measured in 122 patients at auditory assessment. Sensitivity to change in hearing was measured in 36 cochlear implant patients, before and 6 or 12 months after implantation. RESULTS: Test-retest reliability was very satisfactory (ρ=0.88). Internal coherence was good for all questions. External validity, comparing ERSA to APHAB scores in the same non-implanted hearing-impaired patients, was good (ρ=0.52). Additionally, ERSA scores correlated with hearing performance in adverse conditions (monosyllabic words: ρ=0.22; sentences in noise: ρ=0.19). In patients tested before and after cochlear implantation, improvement in hearing performance in silence and in noise correlated with an improvement in ERSA score (ρ=0.37 to 0.59, depending on the test), but not to GBI score. CONCLUSION: The ERSA questionnaire is easy and quick to use, reliable, and sensitive to change in hearing performance after cochlear implantation.

Efficacy of Extracorporeal Photopheresis in Patients With Bronchiolitis Obliterans Syndrome After Lung Transplantation.

BACKGROUND: Lung transplantation (LT) is only therapeutic option for patients affected by chronic respiratory failure. Chronic rejection, also known as bronchiolitis obliterans syndrome (BOS), is still the main cause of death and the most important factor that influences post-transplantation quality of life. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Extracorporeal photopheresis (ECP) seems to reduce the rate of lung function decline in transplant recipients with progressive BOS. METHODS: From 1991 until now, 239 LTs were performed at our center. Fifty-four patients (22.5%) developed BOS; 15 of these (27.7%) were treated with ECP. At the beginning of the treatment, all patients showed a mean decline of forced expiratory volume in 1 second (FEV1) from baseline values of 45.8% ± 17.2%; 2 patients were in long-term oxygen therapy. RESULTS: Mean follow-up from November 2013 to June 2016 was 11.6 ± 7 months. Twelve patients (80%) showed lung function stabilization with an FEV1 range after treatment between -6% to +8% from the pre-treatment values. We did not report any adverse effects or increase of infections incidence. DISCUSSION: ECP seems to be an effective and well-tolerated therapeutic option for LT patients with BOS in terms of stabilization of lung function and increased survival.

Evaluation of Renal Function in Patients Undergoing Lung Transplantation.

BACKGROUND: Acute kidney injury and chronic kidney failure are serious complications after lung transplantation. Glomerular filtration rate (GFR) is the primary indicator of renal function. Several equations have been proposed to evaluate the estimated GFR (eGFR). We compared three different equations to determine which has the better correlation with the development of acute and chronic renal failure in lung recipients. METHODS: Twenty-two patients with a mean age of 54.4 ± 8.5 years underwent lung transplantation from 2010 to 2015. Thirteen (59%) had pulmonary fibrosis, 7 (32%) emphysema, 1 (4.5%) bronchiectasis, and 1 (4.5%) lymphangioleiomyomatosis. In all patients, eGFR was measured preoperatively using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Levey's Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. In 20 patients (90%) eGFR was calculated at 1, 3, and 6 months. RESULTS: According to CKD-EPI and MDRD, eight patients (36.3%) had preoperative reduction in eGFR, whereas 6 patients (27.2%) had preoperative reduction according to the CG (P = .04). The mean values were higher for the CG (103.2 vs. 102 vs. 94.4). Five patients (22.7%) developed perioperative acute renal failure requesting a dialysis treatment; four of these showed a preoperative eGFR to the highest CG (P = .05). At 1 and 6 months after lung transplantation, the CG, MDRD and CKD-EPI eGFR values were, respectively, 86.6, 84.1 and 76.6 mL/min/1.73m2 and 75.8, 72.7, and 72.3 mL/min/1.73m2. CKD-EPI eGFR values are more predictable than the other equations of AKI. CONCLUSIONS: Preoperative assessment of eGFR using the MDRD and CKD-EPI seems to correlate better than the CG to the prediction of acute renal failure, whereas for the chronic form the three equations seem equivalent.

Prevalence of hereditary ataxias and spastic paraplegias in Molise, a region of Italy.

An epidemiological survey of hereditary ataxias and paraplegias was conducted in Molise, a region of Italy (335, 211 inhabitants on 1 January 1989). Total prevalence was 7.5 x 10(-5) inhabitants (95% confidence limits 4.8-11.1). There were 7 patients with Friedreich's disease, 5 with early onset cerebellar ataxia with retained tendon reflexes, 4 with ataxia-telangiectasia, 9 with hereditary spastic paraplegias (2 autosomal dominant and 7 autosomal recessive cases). There was no patient with autosomal dominant cerebellar ataxia.

Lomefloxacin versus trimethoprim/sulfamethoxazole in the treatment of adults with acute bacterial diarrhea.

This study compared the efficacy and safety of lomefloxacin with that of trimethoprim/sulfamethoxazole (TMP/SMX) in the treatment of adult patients with acute diarrhea of bacterial etiology. Two centers enrolled a total of 133 patients; 99 (74%) presented with severe symptoms. The patients were randomized to receive either lomefloxacin 400 mg once daily (n=68) or TMP/SMX 160/800 mg twice daily (n=65) for five days. Bacteriologic success was achieved in 89.5% of evaluation lomefloxacin-treated patients and in 97.5% of patients treated with TMP/SMX. Clinical success was achieved in 100% and 97.5% of patients in the two treatment groups, respectively. The predominant organisms isolated in both groups at baseline, i.e. Shigella flexneri, Vibrio parahaemolyticus, and Salmonella Group D, were eradicated in all patients. Campylobacter jejuni was isolated at baseline in four patients in the lomefloxacin group but in none randomized to receive TMP/SMX; this organism persisted in three patients. Adverse events were experienced by 14 (23%) of the lomefloxacin-treated patients and by 18 (30%) of the TMP/SMX-treated patients. All adverse events reported were mild or moderate in severity and their distribution was similar in both groups. The results of this study show that lomefloxacin 400 mg once daily is as effective as TMP/SMX 160/800 mg twice daily and suggest that lomefloxacin is a promising new quinolone for the treatment of bacterial diarrhea.

[Breast cancer in pregnancy]. / Il carcinoma della mammella in gravidanza.

Breast cancer in pregnancy is a very rare condition. At present this doesn't seem a condition with a particularly grim prognosis. It's often only an underestimate of the mammalian masses in pregnancy which produces a delay in the diagnosis and the consequent grim prognosis. The authors recommend on the basis of their experience a careful control of mammalian masses in pregnancy and an opportune diagnosis that allows to operate as soon as possible. It's likewise underlined that interruption of the pregnancy don't seem to improve the prognosis.

[Clinical-diagnostic considerations of a case of endometrial ossification as a cause of secondary infertility]. / Considerazioni clinico-diagnostiche su un caso di ossificazione endometriale quale causa di sterilità secondaria.

Endometrial ossification is a rare finding. Its aetiology and pathogenesis are controversial. However a history of previous abortion is usually present. It has variable clinical presentations. We report a case in which the patient presented with secondary infertility.

[Congenital factor XIII deficiency in pregnancy. A case report]. / Deficit congenito del fattore XIII in gravidanza. Esposizione di un caso clinico.

Congenital factor XIII deficiency is a rare hemorrhagic syndrome with an altered fibrin stability, hemorrhagic diathesis and habitual abortions. After a short introduction, a case report is described and the clinical differences between plasmatic and platelet deficiency pointed out.

[Current orientation about congenital Cytomegalovirus infection]. / Attuali orientamenti in tema di infezione congenita da Cytomegalovirus.

The CMV infection in pregnancy make serious problems about the diagnosis and the fetal prognosis. Infact primary infection by CMV is loaded by an high risk of congenital infection and the presence of antibodies IgG do not prevent a possible reinfection. Furthermore, the latent presence in the host of CMV induces his reactivation when the immunosorveillance decreases during pregnancy. The consequences of primary infection are well shown during pregnancy and they are very grave, but also the reactivations induce especially neurological consequences, that however are shown only after some months from delivery. Therefore in consideration of the prognosis and the poor therapeutics, the management in these cases is essentially to give minute details to the mother about all the consequences for the fetus without to exclude, because of serious sequels, so that just she can to decide the future of her pregnancy.

[Myelodysplasia in triplet pregnancy]. / Mielodisplasia in gravidanza trigemina.

INTRODUCTION: The myelodysplastic syndromes (MSD) are a group of hematologic disorders that manifest dysplastic hematopoiesis and usually a hypercellular bone marrow. Ineffective hematopoiesis leads to haematologic failure in these syndromes. The MDS are a rare event during pregnancy although the exact incidence is unknown it is likely to be less than that for leukaemia. CLINICAL REPORT: The case, a 29 year old woman, presented during 23rd week of her first, triplet, pregnancy with symptoms of anemia and thrombocytopenia is described. DISCUSSION: The pathogenetic aspect and diagnostic management is discussed, underlined especially under the point of view of the triplet pregnancy. It is suggested that the association of myelodysplastic syndromes during pregnancy is coincidental and that acute leukemia evolves in a majority of these cases. Furthermore, refractory macrocytic anemias in pregnancy need to be carefully evaluated for a primary myelodysplastic state.

Lung transplantation for cystic fibrosis: outcome of 101 single-center consecutive patients.

Bilateral sequential lung transplantation (BSLT) is nowadays considered a valid therapeutic option for patients with end stage cystic fibrosis. We report our experience with 104 BSLTs in 101 patients. The overall survivals at 1, 3, 5, 10 years were 79%, 65%, 58%, and 42%, respectively. Perioperative mortality was 14.8% (n = 15). The leading causes of perioperative mortality were primary graft dysfunction and sepsis. Three patients were retransplanted owing to obliterative bronchiolitis. In 70 cases (69%), patients displayed ≥ 1 additional risk factors: previous lung resections, colonization by Burkholderia cepacia, diabetes, pneumothorax, or noninvasive ventilatory support. The mean preoperative 1-second forced expiratory volume of 0.69 ± 0.2 L (22%) increased to 85% at 1 year after the operation. The mean time on the waiting list was 12 ± 5 months. The 5 patients treated with extracorporeal membrane oxygenation before urgent transplantation were operated after 3, 5, 6, 30, and 3 days respectively. During the procedure, cardiopulmonary bypass was required in 33 patients (32%). Lung transplantation represents a unique opportunity to ameliorate the quality and improve the survival of patients affected by cystic fibrosis. Timing of referral and patient selection remain crucial for success.

Extracorporeal membrane oxygenation as bridge to lung transplantation.

Lung transplantation (OLT) is a viable option for end-stage pulmonary diseases in selected patients with satisfactory long-term results. However, the paucity of available donors engenders a prolonged stay on the waiting list with progressive decline of lung function. In cases of sudden respiratory failure, admission to an intensive care unit with institution of extracorporeal membrane oxygenation (ECMO) may be an option while a waiting an emergency OLT. In 12 OLT candidates we started ECMO because of acute decline of lung function. Eleven patients had cystic fibrosis and the other subject, histiocytosis X. In 7 patients bilateral OLT was performed after a mean waiting time of 6 days from ECMO institution; 5 patients died on ECMO at a mean time of 11.6 days. After OLT 2 patients required reoperation for hemothorax; renal failure and acute leg ischemia occurred in 2 patients. The mean weaning time from ECMO after OLT was 2.14 days. No patient died in the perioperative period and 1-year survival was 85.7%. ECMO represents a valid option as a bridge to urgent OLT for selected candidates.

Ethanol retains its ability to modify endogenous opiate system in aged rats.

The effect of chronic ethanol administration (8% in the drinking water for 28 days) on opiate receptor function at striatal level was studied in adult (3 months) and aged (24 months) male Sprague Dawley rats. The treatment produces supersensitivity of striatal delta opiate receptors which may be ascribed to an inhibitory effect of ethanol on endogenous opiate release. In contrast the affinity of mu receptors is decreased. These changes are qualitatively and quantitatively similar in young and old rats.

[Electrocardiographic changes during at term labor]. / Modificazioni elettrocardiografiche durante travaglio di parto a termine.

BACKGROUND: Electrocardiographic ST-changes are known to occur during pregnancy, puerperium and cesarean section or spontaneous labor under oxytocic, tocolytic and anesthetic treatment. The aim of the study was to detect ST-changes during spontaneous labor in healthy women, without anesthetic or oxytocic therapy, and to verify their relation to plasmatic electrolyte variations and other pathophysiologic factors. METHODS: Electrocardiograms were performed in 46 healthy women (age 30.4 +/- 6) at term pregnancy, during labor, 12-24 hours after delivery and then again three months after delivery. Hemochrome and sideremia were tested before labor and electrolytes (Na, K, Cl, Mg, Ca) were tested during each electrocardiogram. The patients were divided in two groups, patients with (group A) and without (group B) ST-changes. RESULTS: Before labor, three patients (7%) were in group A with nonspecific ST-changes (flat ST and/or fluctuating T wave) in precordial leads V2-V3-V4; group B had 43 patients (93%). During labor, group A included 27 patients (59%): 16 (59%) showed T inversion, 23 (85%) nonspecific changes, and eight (30%) had ST shift < or = 0.5 mm, in precordial and inferior leads. The three patients in group A before labor showed increased changes during labor. Group B had 19 patients (41%). Heart rate and blood pressure were within normal range in all patients. Early after delivery, seven patients out of 27 in labor were still in group A (15% of total) with nonspecific ST-changes; group B had 39 patients (85%). Three months after delivery, all patients were in group B. A drop in plasmatic K, detected during labor in all patients and returning to normal soon after delivery, was higher in group A than in group B (p < 0.01). CONCLUSIONS: ST-changes detectable during labor, similar to the ones described during pregnancy and puerperium but greater and more frequent, are independent of anesthetic and/or oxytocic treatment; they are not ischemic and disappear after delivery. They are related to the drop in plasmatic K, hyperventilation, hormonal changes, uterine contractions, O2-consumption and pain.

[A case of the Solomon syndrome]. / Un caso di sindrome di Solomon.

The authors describe a trisintomatic case (with cutaneous, neurological and osseous alterations) of a syndrome of Solomon. The case appears peculiar for the tardy beginning of the manifestations.

[Role of hypernephroma in a case of intracerebral hemorrhage as a 1st sign of metastasis. Case report]. / Ruolo dell'ipernefroma in un caso di emorragia intracerebrale come primo segno di metastasi. Caso clinico.

They have reported a case of multiple hepatic and cerebral metastasis of hypernephroma. The cerebral metastasis, probably after the hepatic one, are present respectively at a cerebellar and parietal-occipital level; the latter is the cause of a cerebral haemorrhage in a quite precocious phase of development.

A structural DNA binding protein of African swine fever virus with similarity to bacterial histone-like proteins.

Here we describe an African swine fever virus (ASFV) protein encoded by the open reading frame 5-AR that shares structural and functional similarities with the family of bacterial histone-like proteins which include histone-like DNA binding proteins, integration host factor, and Bacillus phage SPO1 transcription factor, TF1. The ASFV 5-AR gene was cloned by PCR and expressed in E. coli. Monospecific antiserum prepared to the 5-AR bacterial expression product specifically immunoprecipitated a protein of approximately 11.6 kDa from ASFV infected swine macrophages at late times post infection. Additionally, the 5-AR expression product was strongly recognized by ASFV convalescent pig serum, indicating its antigenicity during natural infection. Cloned p11.6 bound both double and single stranded DNA-cellulose columns. Consistent with a DNA binding function, immunoelectronmicroscopy localized p11.6 to the virion nucleoid, To our knowledge, p11.6 is the first bacterial histone-like DNA-binding protein found in an animal virus or eukaryotic cell system.