Prevention of the spread of SARS COV-2 by Rapid Antigenic Tests on the passengers entering an Italian seaport.

Abstract: Out of 38,282 passengers entering Italy at a major seaport, submitted to SARS-CoV-2 rapid antigenic test, 272 (0.6%) resulted positive and 212 (93.4%) were confirmed positive by qRT-PCR, leaving a 0.6% of false positive. Those resident in the area under control of the same Local Health Authority of the seaport were immediately submitted to isolation and investigated for contact tracing, the others notified to their Local Health Authority which did the same in the following day. This procedure was made possible by a full-time dedication of the local healthcare workers who managed all the passengers disembarking around the clock along the months of the emergency.

Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review.

BACKGROUND AND AIMS: Ascertainment bias (AB) indicates a bias of an evaluation centre in estimating the prevalence/incidence of a disease due to the specific expertise of the centre. The aim of our study was to evaluate classification of different types of dementia in new cases appearing in secondary and tertiary centres, in order to evidence possible occurrence of AB in the various (secondary to tertiary) dementia centres. METHODS: To assess the mechanism of AB, the rates of new cases of the different forms of dementia reported by different centres were compared. The centres involved in the study were 11 hospital-based centres including a tertiary centre, located in the University Department of Clinical Neurology. The tertiary centre is endowed with state-of-the-art diagnostic facilities and its scientific production is prominently focused on dementia with Lewy bodies (DLB) thus suggesting the possible occurrence of a bias. Four main categories of dementia were identified: Alzheimer's disease (AD), DLB, fronto-temporal dementia (FTD), vascular dementia (VaD), with other forms in a category apart. The classification rate of new cases of dementia in the tertiary centre was compared with rates reported by secondary centres and rates of recoding were calculated during a follow-up of 2 years. RESULTS: The study classified 2,042 newly diagnosed cases of dementia in a population of 1,370,000 inhabitants of which 315,000 were older than 65. AD was categorized in 48-52 % of cases, DLB in 25-28 %, FTD in 2-4 % and VaD in 17-28 %. During the 2-year follow-up the diagnosis was re-classified in 40 patients (3 %). The rate of recoding was 5 % in the tertiary centre, 2-8 % in referrals from secondary to tertiary centre, 2-10 % in recodings performed in secondary centres and addressed to tertiary centre. Recoding or percentages of new cases of AD or DLB were not different in the comparison between secondary or between secondary and tertiary centres. FTD and VaD were instead significantly recoded. CONCLUSION: The results of the study suggest that in a homogeneous area, AB is not interfering with diagnosis of AD or DLB.

Cefixime-induced nonconvulsive status epilepticus.

Nonconvulsive status epilepticus (NCSE) is an epileptic condition lasting >30 min, clinically manifested by an altered mental state and associated with continuous epileptiform activity on the electroencephalogram. NCSE is a common yet still under recognized condition and delay in diagnosis and treatment may be associated with increased mortality as well as cognitive/behavioral consequences. We described an epileptic female patient assuming carbamazepine (900 mg/day) and levetiracetam (3,000 mg/day), seizure free for more than 10 years, who developed NCSE during cefixime treatment, a third-generation cephalosporin compound that along with penicillins is classified within the b-lactam class of antibiotics. In our report we outline the importance and the difficulty to choose secure antibiotic treatment in epileptic patients, we discuss the possible mechanisms by which cephalosporins induce neurotoxicity and the need to stress family components questioning about new drugs assumed. Finally we highlight the value of the EEG recording to diagnose NCSE and treat it adequately and promptly.

The role of arterial embolization in blunt splenic injury.

PURPOSE: The aim of study was to evaluate the results of our experience with transarterial embolization based on a modified algorithm in patients with splenic injury. MATERIALS AND METHODS: We collected data of patients admitted to our hospital from January 2006 to August 2008 for blunt splenic injury. During this period, 46 patients were admitted for splenic trauma, of whom 17 were treated surgically, 15 conservatively and 14 with percutaneous embolisation (13 men, mean age 44.8, mean injury severity score 18.5, six with grade IV and eight with contrast blush). Patients in shock were referred for laparotomy and splenectomy, whereas those who were haemodynamically stable or responsive to fluid resuscitation were further evaluated with computed tomography (CT). In the presence of imaging evidence of splenic injury ranging from grade I to grade III (n=15) a conservative approach was adopted, whereas haemodynamically unstable patients with grade V injury (n=17) were treated with splenectomy. Embolisation was performed in 14 patients with grade IV injury or in the event of contrast extravasation, regardless of injury grade. In patients with diffuse organ damage, we embolised the main splenic artery, whereas in the case of localised injury, embolisation was selective. RESULTS: Proximal embolization was required in eight cases and distal coil embolization in six. In 13 cases, we placed magnetic-resonance-compatible coils 4-6 mm in diameter; only one patient was treated with gel-foam injection. Immediate technical success was achieved in all cases. In 13/14 patients (92.9%), no periprocedural complications were observed, whereas the remaining patient underwent splenectomy within 24 h due to recurrent bleeding. CONCLUSIONS: On the basis of our algorithm, it is possible to reach a quick decision on the most appropriate treatment for patients presenting with blunt abdominal trauma, and splenic artery embolization seems to offer a reliable option in those with high-grade splenic injury or active bleeding.

First pregnancies in jennies with vitrified donkey semen using a new warming method.

Sperm vitrification has been recently developed, but fertility trials have not been performed yet in equine species. In this study, a new warming technique for vitrified donkey semen was developed and the uterine inflammatory response and fertility were compared to conventional freezing. In Experiment 1, sperm was vitrified in straws and warmed in 3 ml of extender or in a water bath at: 37 °C/30 s; 43 °C/10 s; and 60 °C/5 s. Sperm motility, plasma and acrosome membranes and DNA integrity were compared between treatments. In Experiment 2, jennies were inseminated twice (500 × 106 sperm) in the uterine body either with vitrified or frozen semen (2 cycles/jenny). Pregnancy rates and the uterine inflammatory response (polymorphonuclear neutrophil concentration; PMN) were evaluated after artificial insemination (AI). No differences between warming in extender/water bath were found and 43 °C/10 s was better than lower temperatures in terms of total (53.8 ±â€¯13.2%) and progressive sperm motility (41.4 ±â€¯11.4%). No differences in PMN concentration (×103 PMN/ml) were found between vitrified (276.8 ±â€¯171.6) or frozen (309.7 ±â€¯250.7) semen after AI. However, PMN decreased faster (P < 0.05) using vitrified semen. Pregnancy rates were greater for vitrified (22%) than frozen semen (10%) but not statistically different. In conclusion, donkey sperm vitrified in straws could be directly warmed in a water bath at 43 °C/10 s, reducing the uterine inflammatory response obtained after AI and promoting positive pregnancy outcomes. These findings confirm the possibility to use vitrified semen as an alternative for AI in jennies.

Protracted benefit from paradoxical kinesia in typical and atypical parkinsonisms.

Paradoxical kinesia (PK) is the sudden resolution of a previously stabilized akinesia in an advanced idiopathic Parkinson's disease (IPD) patient facing an immediate threat. We are reporting the effect of PK, as a consequence of a life threatening event (earthquake), in a group of 14 patients with parkinsonism and dementia in Hoehn/Yahr (H/Y) stage 3-5. All the patients presented an extraordinary motor response during the earthquake that has recently stricken the Italian city of L'Aquila. All of them were able to safely escape unaided and, in some cases, to assist their families, despite they suffered before from severe night time akinesia and gait difficulties with postural instability requiring assistance. In five patients, the improvement of motor disabilities, particularly of freezing, lasted for 2-5 months.

Considerations for the development of a dromedary camel (Camelus dromedarius) semen collection centre.

The dromedary camel (DC) is a strategic animal for the exploitation of the desert and unhospitable lands (arid and semiarid areas). These animals are a genetic resource, locally adapted and more resilient to these environs, that may significantly contribute to food security and sustainable development of marginal land areas. Artificial insemination is the least invasive, least expensive technique for improving genetic selection and minimising transmission of venereal disease among animals and herds. Besides semen preservation protocols, specific approaches for the development of DC semen collection centres - biosecurity measures, screening for infectious diseases, management of animals, welfare, nutrition, control of seasonality, training, hygiene of semen collection and processing - have been considered less important aspects. The aim of this research is to describe the aspects related to the development of a DC semen collection centre, summarising the latest studies in the field of welfare, reproduction and diseases, and describing biosecurity and hygiene aspects related to semen collection and handling. Scientific gaps and requirements for maximising the production of good quality and safe-to-use semen doses with minimal risks of disease transmission are also described.

Ramifications of protease-based liquefaction of camel semen on physical, kinematic and surface glyco-pattern of cryopreserved spermatozoa.

The efficiency of incorporating different proteases in the diluent for reducing camel semen viscosity, and subsequent ramifications on morpho-functional and glycan surface properties of cryopreserved spermatozoa were investigated. Ejaculates (n = 48) were collected from three adult camels, Camelus dromedarius, during the breeding season (January - March). A portion of each raw ejaculate was evaluated for sperm physical and morphological traits, whereas the other portion was divided into three aliquots assigned for the following liquefaction treatments: control (untreated), 0.1 mg/mL papain or 5 U/mL bromelain. All samples were diluted with Tris-lactose diluent containing the anti-enzyme E-64 to neutralize both proteases before being processed for cryopreservation. Post-thaw physical and kinematic properties of spermatozoa were analyzed using a computer-assisted sperm analysis (CASA) system. The sperm surface glycocalyx pattern was evaluated with a panel of 14 fluorescent lectins. Although bromelain was more effective in elimination of semen viscosity, there was a negative correlation between bromelain supplementation and values for the variables: normal sperm, intact acrosome and intact sperm cell membrane. Bromelain supplementation, compared to papain-treated and control samples, was positively correlated with secondary sperm abnormalities, increased straight-line velocity (VSL, µm/s) and straightness (%) of spermatozoa. Results from the glycan analysis indicated that both proteases did not affect the N-linked glycan content of the entire sperm surface, whereas the treatment with proteases induced little change in N-acetylgalactosamine and fucose terminating glycans in the tail region of the sperm. Functional studies are needed to evaluate the sperm fertility rates of bromelain- and papain-treated semen for application in camel assisted reproductive technologies.

Uterine artery embolization in the treatment and prevention of postpartum hemorrhage.

OBJECTIVES: The study was conducted to evaluate the efficacy of superselective transcatheter uterine artery embolization for control of obstetric hemorrhage. METHODS: Between January 2002 and December 2005, 14 consecutive patients underwent uterine artery embolization to control postpartum hemorrhage, and two to prevent hemorrhage before second-trimester therapeutic abortion. RESULTS: Embolization was performed by transfemoral arterial catheterization. Pieces of absorbable gelatin sponge were used in all cases, with the addition of platinum coils in two cases for complete vessel occlusion. Optimal bleeding control was achieved in all cases but one--a patient who underwent hysterectomy due to embolization failure. No severe complications were observed. CONCLUSIONS: The high success rate, low morbidity rate, and possibility of preserving reproductive function have made superselective uterine artery embolization the technique of choice to control life-threatening, intractable postpartum hemorrhage in hemodynamically stable patients, provided multidisciplinary medical teams are promptly available.

Spatial distribution of heavy hydrocarbons, PAHs and metals in polluted areas. The case of "Galicia", Spain.

The aim of this work is to verify the impact of anthropogenic activities and the effects of accidental events, e.g. oil spills, on the marine environment. For this reason, marine sediments and soil samples were collected in the inner part of Vigo and Pontevedra bays, in the Galicia region, northwest Spain, an area interested by many events of oil spills and also characterized by coastal areas with intense anthropic activities; also Cíes Islands, a natural protected area facing the Vigo bay, was investigated, as background site. PAHs, heavy hydrocarbons and metals were analyzed according to standard methods, in order to satisfy quality assurance and quality check constraints. Total PAHs concentration (Σ16 compounds) were in the range of 25-4000ng/g, and 30-800ng/g for marine sediments and soil samples, respectively. Even some samples from the Cíes Islands, show a contamination with values achieving >200ng/g of PAHs. Although contamination levels have been shown to be strong at several locations in the study area, their ranges are those typical of other estuarine sites, with PAHs and hydrocarbons primarily of pyrolytic origin. This observation was further confirmed by enrichment factors of some metals (Cd, Cu, Pb and Zn) that match to those of harbor and shipyard zones of the main industrial and commercial maritime areas.

[Comparative analysis of nutritional status, food intake and length of hospitalization considering two hospitals: public versus private]. / Comparación del estado nutricional, consumo alimenticio y tiempo de hospitalización de pacientes de dos hospitales, uno público y otro privado.

INTRODUCTION: To assess the nutritional status of hospitalized patients is important for the prevention of hospital malnutrition and planning of nutritional intervention. OBJECTIVE: To comparatively analyze the nutritional status of patients admitted to two hospitals, one public and another private, caring for populations with different socioeconomic profiles. CASE STUDY AND METHODS: This was a prospective study and samples were collected from patients of two hospitals, one public (PUH) and another private (PRH), which respectively represent the underprivileged and the more affluent populations. The analysis considered 51 patients from the PUH, aged between 53.9 +/- 15.6 years and 51 from the PRH, aged between 55.0 +/- 13.9 years, paired and grouped according to the following diseases: neoplasia (n+25), digestive tract disorders (n+11) and others (n+15). The statistical analysis was made by means of the T-Student test to compare PUH and PRH variables with p < 0.05, as well as to compare different variables in the same hospital, with p < 0.05; p < 0.01; p < 0.005 and p < 0.001. RESULTS: There were no statistical differences when the variables evaluated in both hospitals were compared, except for the length of hospitalization of patients with digestive tract disorders, which was longer for HPR. Upon hospitalization, 21.0% and 17.6% presented a body mass index (BMI) indicative of malnutrition. The patients with neoplasias presented current weight (CW) lower than habitual weight (HW). Both the patients with neoplasias and those with digestive tract disorders presented insufficient energy consumption in the period before hospitalization (p < 0.05). A negative correlation was found between the length of hospitalization and the current weight/habitual weight ratio (r = 0.194, 0 < 0.05, n = 102) and BMI (r=-0.186, p < 0.05, n = 102), according to Pearson's coefficient. CONCLUSION: The similarity of nutritional conditions found points to similarity of nutritional status for patients of both institutions and reflects the changes in the nutritional status of the population. The nutritional intervention should consider the nutritional needs of the population assisted.

Behavioral indicators to detect ovarian phase in the dromedary she-camel.

This pilot study was conducted to test the hypothesis that female camels behave differently in various ovarian phases in the presence of a restrained male camel. The aim was to identify behavioral patterns which could be used as indicators to detect ovulatory phase by visual observation in the presence of a restrained virile bull. Twenty-four healthy, nonpregnant, and nonlactating adult females were used. Transrectal ultrasonography was performed for each animal once a week over a 3-week period to determine the phase of the ovarian cycle. Females were considered to be in the ovulatory phase (O) when there was at least one preovulatory follicle (12<Ø<19 mm) protruding from the ovarian surface, and in the nonovulatory phase (NO), when growing follicles, regressing follicles, or corpora lutea were detected. Immediately after examination, each female was freely exposed to a restrained bull for 15 minutes, and her behaviors were filmed. The videos were analyzed through a focal animal-sampling ethogram (states: looking at the male; looking outside; standing close to the male; searching; and lying down; events: interaction with the male; urination; defecation; sound emission; and steps). A score for tail position (tail score: 1 = close to the vulva, 2 = horizontal, 3 = vertical) and for interest in the bull (male time score: from 1 to 5; 1 = <20% of observation period spent near the bull; 5 = more than 80%) were recorded. Ovulatory phase camels showed higher interest in the male than nonovulatory phases: they stood close to the male for longer periods (P = 0.0159), interacted with the male more frequently (P = 0.0004), and tended to lie down in front of him (P = 0.1202). Moreover, ovulatory phase had a significant effect on male time score (P < 0.01), mature follicular ovarian phase being associated with higher scores. Seeking the male has already been proposed as a behavioral indicator of estrus in camels, this has now been confirmed using a standardized ethogram. The present results clarify that camels behave differently in different ovarian phases and that monitoring their behavior in the presence of a restrained bull could help detect their ovulatory phase. This would have profound implications for enhancing fertility in dromedary camels by improving timing of mating or artificial insemination.

Percutaneous renal artery embolization of nonfunctioning allograft: preliminary experience.

Percutaneous renal artery embolization has been introduced as an alternative to nephrectomy for patients with a nonfunctioning allograft and Graft Intolerance Syndrome. The symptoms resulting from this syndrome include fever, local pain, hypertension, and hematuria. From April 2003 to October 2003, 5 patients were treated with this technique. The intraparenchymal renal arteries were embolized by injection of calibrated tris-acryl gelatin microspheres of increasing size (from 100-330 to 700-900 microm) and completed with the insertion of 5-mm-8-mm steel coils in the renal artery. The procedure was well tolerated in all cases; no major complications occurred. In 3 patients, the symptoms disappeared immediately. In 1 patient, it was necessary to perform a second embolization due to collateral circulation developing from a lumbar artery; this further procedure resolved the symptoms. In the last case, the patient underwent nephrectomy because of septic fever. In conclusion, patients with this syndrome refractory to medical treatment may be treated by the effective and minimally invasive procedures of percutaneous allograft artery embolization with no significant short-term or late complications.

Chemical characterization and spatial distribution of PAHs and heavy hydrocarbons in rural sites of Campania Region, South Italy.

In this paper, the behaviour and distribution patterns of heavy hydrocarbons and several polycyclic aromatic hydrocarbon (PAH) priority pollutants, as listed by the US Environmental Protection Agency, were evaluated in 891 soil samples. The samples were collected in three expected polluted rural sites in Campania (southern Italy) as part of the LIFE11 ECOREMED project, funded by the European Commission, to test innovative agriculture-based soil restoration techniques. These sites have been selected because they have been used for the temporary storage of urban and building waste (Teverola), subject to illicit dumping of unknown material (Trentola-Ducenta), or suspected to be polluted by metals due to agricultural practices (Giugliano). Chemical analysis of soil samples allowed the baseline pollution levels to be determined prior to any intervention. It was found that these areas can be considered contaminated for residential use, in accordance with Italian environmental law (Law Decree 152/2006). Statistical analysis applied to the data proved that average mean concentrations of heavy hydrocarbons could be as high as 140 mg/kg of dry soil with peaks of 700 mg/kg of dry soil, for the Trentola-Ducenta site; the median concentration of analytical results for hydrocarbon (HC) concentration for the Trentola-Ducenta and Giugliano sites was 63 and 73.4 mg/kg dry soil, respectively; for Teverola, the median level was 35 mg/kg dry soil. Some PAHs (usually benzo(a)pyrene) also exceeded the maximum allowed level in all sites. From the principal component analysis applied to PAH concentrations, it emerged that pollutants can be supposed to derive from a single source for the three sites. Diagnostic ratios calculated to determine possible PAH sources suggest petroleum combustion or disposal practice. Our sampling protocol also showed large dishomogeneity in soil pollutant spatial distribution, even at a scale as small as 3.3 m, indicating that variability could emerge at very short spatial scales.

Renal vascular reactivity in the bile duct-ligated rat.

The renal dysfunction associated with liver disease appears to be caused by decreased renal perfusion. Altered renal vascular reactivity (RVR) may contribute to the development of decreased renal blood flow. This study was undertaken to assess the effect of bile duct ligation (BDL) on RVR to norepinephrine and angiotensin II in the rat and to evaluate the role of prostaglandins in the modulation of altered RVR. Male Sprague-Dawley rats underwent either sham operation (SO) or BDL. Four days later, isolated kidney perfusions were established. Dose-response curves to norepinephrine (SO, n = 9; BDL, n = 10) and angiotensin II (SO, n = 7; BDL, n = 9) were obtained. The perfusate was modified to contain indomethacin, 10(-6) mol/L, and dose-response curves to norepinephrine (SO, n = 10; BDL, n = 8) and angiotensin II (SO, n = 4; BDL, n = 8) were obtained as well. Baseline resistances did not differ between any of the groups. RVR to norepinephrine did not appear to be altered by BDL; however, increased RVR to norepinephrine was unmasked by inhibition of prostaglandin synthesis. BDL did not affect the RVR to angiotensin II with or without indomethacin. BDL is associated with an increase in renal vascular sensitivity to norepinephrine, which is balanced by a compensatory increase in renal prostaglandin activity in response to norepinephrine stimulation. These findings are consistent with theories that decreased renal perfusion associated with liver disease may be mediated by catecholamines.

Goserelin acetate to avoid hysterectomy in pre-menopausal women with fibroids requiring surgery.

OBJECTIVE: To obtain information on the efficacy of repeated short cycles of GNRH agonist treatment in order to avoid hysterectomy in near-menopausal women with symptomatic fibroids. STUDY DESIGN: 72 pre-menopausal women (mean age 50 years) with one or more uterine fibroids >10 cm in diameter, symptomatic menorrhagia lasting three months or more and haemoglobin=9 g/dl entered the study. The patients were randomized with ratio of approximately 1:4 to: (a) immediate surgery; or (b) treatment with goserelin acetate. Patients randomized to goserelin acetate received a first cycle of 3.6 mg depot once every 28 days for four months. They were followed-up for three years. If menorrhagia was observed during the follow-up the woman was given goserelin acetate 3.6 mg depot for another three months. In case of further menorrhagia, a third cycle of goserelin acetate 3.6 mg depot for three months was given. After the third cycle of therapy if there was still menorrhagia, the patient underwent hysterectomy plus bilateral oophorectomy. RESULTS: A total of 13 women were assigned to the immediate surgery group and 59 to goserelin. Three years after trial entry a total of 23 women allocated to goserelin acetate treatment had undergone hysterectomy. CONCLUSION: This study suggests that GNRH agonists are efficacious for avoiding hysterectomy in women near menopause with uterine fibroids.

Hypothenar hammer syndrome. Retrospective study of nine cases.

The hypothenar hammer syndrome is an uncommon lesion of the ulnar artery caused by repetitive trauma to the ulnar portion of the hand. It characteristically occurs in the dominant hand of middle-aged craftsmen, but also in athletes practising various types of sports. We present a retrospective study of nine patients between 1988 and 1999. The follow-up ranged from 1 to 10 years. We recommend surgical treatment, by resection of the involved arterial segment and revascularization either by direct anastomosis or by means of a venous interpositional graft.

[Digital nerve block anaesthesia: historical development and two cases of finger-tip necrosis, a rare complication]. / Fingerblock-Anästhesie - Uber die geschichtliche Entwicklung und zwei Fälle einer Fingernekrose als seltene Komplikation.

Two cases of finger-tip necrosis following digital blocks are presented. These are rare complications of this technique. Pathogenesis and treatment options are discussed and the literature reviewed. Circulatory problems can be avoided by using adrenalin free anaesthetics, infiltrating at the metacarpal level with small volumes, and using upper-arm tourniquets instead of rubber bands at the phalangeal level.

[Mallet-thumb--presentation and discussion of 3 cases of a rare lesion]. / Der Mallet-Daumen--Vorstellung und Diskussion von drei Fällen einer seltenen Läsion.

Three cases of closed extensor tendon ruptures without osseous involvement in Verdan's zone 1 of the thumb (Mallet thumb) are presented and the various treatment options discussed based on the pertinent literature. As a consequence of the special anatomy of the thumb's extensor tendons which differs from that in the fingers, we recommend surgical treatment of this rare lesion by transosseous refixation of the ruptured tendon. Thus, early postoperative motion can be initiated resulting in rapid recovery of complete function.

[Horizontal transmission of hepatitis C virus to family members of infected polytransfused pediatric patients]. / Transmissione orizzontale del virus dell'epatite C tra i familiari di pazienti pediatrici politrasfusi infetti.

The aim of this study is to evaluate the prevalence of the HCV antibodies in the relatives of polytransfused patients with different haemoglobinopathies. Our results have shown that 4.7% of relatives are aHCV positive. This incidence is much higher than that one reported in scientific publications with regard to non-haemoglobinopathis aHCV positive patients. Therefore a careful prevention and surveillance is needed in order to avoid the risk of infection in these subjects.