External validation of the DASH prediction rule: a retrospective cohort study.

Essentials Predicting recurrences may guide therapy after unprovoked venous thromboembolism (VTE). We evaluated the DASH score in 827 patients with unprovoked VTE to verify prediction accuracy. A DASH score ≤ 1 had a cumulative recurrence risk at 1 year of 3.6%, as predicted by the model. The DASH score performed better in younger (< 65 years old) subjects. SUMMARY: Background The DASH prediction model has been proposed as a guide to identify patients at low risk of recurrence of venous thromboembolism (VTE), but has never been validated in an independent cohort. Aims To validate the calibration and discrimination of the DASH prediction model, and to evaluate the DASH score in a predefined patient subgroup aged > 65 years. Methods Patients with a proximal unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE) who received a full course of vitamin K antagonist or direct oral anticoagulant (> 3 months) and had D-dimer measured after treatment withdrawal were eligible. The DASH score was computed on the basis of the D-dimer level after therapy withdrawal and personal characteristics at the time of the event. Recurrent VTE events were symptomatic proximal or distal DVT/PE, and were analyzed with a time-dependent analysis. Observed 12-month and 24-month recurrence rates were compared with recurrence rates predicted by the DASH model. Results We analyzed a total of 827 patients, of whom 100 (12.1%) had an objectively documented recurrence. As compared with the original DASH cohort, there was a greater proportion of subjects with a 'low-risk' (≤ 1) DASH score (66.3% versus 51.6%, P < 0.001). The slope of the observed versus expected cumulative incidence at 2 years was 0.71 (95% confidence interval 0.51-1.45). The c-statistic was lower for subjects aged > 65 years (0.54) than for younger subjects (0.72). Conclusions These results confirm the validity of DASH prediction model, particularly in young subjects. The recurrence risk in elderly patients (> 65 years) was, however, > 5% even in those with the lowest DASH scores.

A new flow cytometric assay for the evaluation of phagocytosis and the oxidative burst in whole blood.

Phagocytes play an important role in host defence against microorganisms and different techniques are needed to evaluate their functional activities. Here we describe a rapid, simple and reliable one step procedure to measure the phagocytosis rate and oxidative burst activation of both polymorphonuclear leukocytes (PMN) and monocytes, by means of flow cytometry using only small quantities of whole blood. The two species of bacteria employed as test microorganisms, Staphylococcus aureus and Candida albicans showed a somewhat different behaviour. We found that the present method could be used as an alternative test in the diagnosis of chronic granulomatous disease (CGD). Moreover we were able to analyse, in a one step procedure, defective phagocyte functions in a group of paediatric patients suffering from recurrent microbial infections.

Characterization of the first tick isolate of Borrelia burgdorferi from Italy.

We report on the first isolation of a spirochetal organism from Ixodes ricinus ticks of the Trieste area (Northern Italy) which was identified as Borrelia burgdorferi by its reactivity with specific monoclonal antibodies directed against the OSPA and flagella proteins.

Mycobacterium tuberculosis isolates belonging to katG gyrA group 2 are associated with clustered cases of tuberculosis in Italian patients.

Fifty-one consecutive isolates of Mycobacterium tuberculosis, collected during a 2-year period in the north-east of Italy, were subjected to IS6110-RFLP analysis to detect the presence of clusters and assigned to one of the three genotypic groups delineated by single nucleotide polymorphisms in the genes katG and gyrA. All the isolates collected from the local population belonged to group 2 or 3, while group 1 isolates were found only in specimens collected from African immigrants. Clustered cases of tuberculosis, which are likely to be related to recently transmitted infection, were found to be significantly associated with katG gyrA group 2. In the local situation, strains belonging to this group may therefore present a higher risk of transmission.

Three scenarios of clinical claim reimbursement for nosocomial infection: the good, the bad, and the ugly.

We studied the extent to which hospitals can expect to receive reimbursement for costs relating to nosocomial infections (NI) under the diagnosis-related groups (DRG) system of clinical claims and calculated the loss of reimbursement due to missed or incorrect registration of infective complications on hospital discharge records (HDR). We calculated clinical claim reimbursement in three scenarios: the good, in which all NI are recorded on HDR; the bad, in which a proportion of NI recorded on HDR observed at the 41 participating hospitals; the ugly, in which none of the NI are recorded on HDR. We analysed in which patients the recording of infective complications changed the DRG clinical claim and the economic consequences on reimbursements. Compared with the ugly scenario, the bad scenario, which is closest to what actually occurs, with only 55.9% of NI (180/322) properly recorded, produced an increased DRG clinical claim in 30 cases, of on average 403 for every NI. Compared with the ugly scenario, the good scenario, produced an increased DRG clinical claim in 45 cases with an average reimbursement of 618. The difference between the bad and the good scenarios shows an average loss of 215 for every case. Our calculated good scenario could cover only 3.8% of direct costs per case attributable to NI. Real, tangible benefits in health, both social and economic, will only accrue from the monitoring and control of NI in hospitals.

Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000.

A one-day survey was carried out in 88 out of 113 public hospitals in Lombardy to obtain prevalence rates of hospital-acquired infections (HAIs) by hospital departments and to identify the pathogens more frequently involved. In total 18667 patients were surveyed, representing 72% of the average daily total of occupied beds in public hospitals in Lombardy. The overall prevalence of HAI was 4.9%. The highest prevalence was observed in intensive care units and in spinal units. The prevalence of bloodstream infections was 0.6%; pneumonia 1.1%; urinary tract infections 1.6% and gastrointestinal infections 0.4%. In surgical patients the prevalence of surgical site infections was 2.7%. The most frequently isolated pathogen from all sites of infections was Escherichia coli (16.8%), followed by Staphylococcus aureus (15.0%), Pseudomonas aeruginosa (13.2%) and Candida spp. (8.7%). Methicillin-resistant S. aureus accounted for 23% of all isolated S. aureus. The results provide baseline data for rational priorities in allocation of resources, for further studies and for infection control activities.

Mutagenic activity of platinum and ruthenium complexes.

cis-Dichlorodiammineplatinum(II) [cis-PtCl2(NH3)2] and dichlorotetrakis (dis-methylsulfoxide) ruthenium(II) [RuCl2(DMSO)4] have been tested as mutagens for strains of Salmonella typhimurium carrying the hisG46 missense mutation. Their activity, which has been compared with the activity of mitomycin C, depends on the presence in the test bacteria of the pKM101 plasmid and is affected in various ways by the function of the excision repair system. More precisely, mitomycin C is mutagenic only for strains with an intact uvr system. cis-PtCl2(NH3)2 and RuCl2(DMSO)4 are mutagens both for uvrB and uvr+ strains, but cis-PtCl2(NH3)2 is more active on the latter, while the converse is true for RuCl2(DMSO)4. It seems, therefore, that each drug interacts with DNA by a different mechanism.

In-vitro antimycobacterial activity of new synthetic amidrazone derivatives.

After preliminary in vitro screening of 15 newly synthesized compounds belonging to the chemical class of N1-(aryliden)-4-pyridinecarboxyamidrazones against Mycobacterium tuberculosis reference strain H37 Rv, we determined the minimum inhibitory concentrations (MICs) of the six most promising chemicals against different species of Mycobacterium and different strains of M. tuberculosis. The agar dilution method was employed against M. gordonae, M. bovis, M. kansasi, M. avium, M. fortuitum and on eighteen different strains of M. tuberculosis, isolated from human bronchial aspirates. The results obtained confirmed that the newly synthesized chemicals possessed a very interesting antitubercular activity, their MICs ranging from 4 micrograms/ml to 16 micrograms/ml.

Preliminary evaluation of in-vitro antimycobacterial properties of N1-(aryliden)-2-pyridinecarboxyamidrazones.

After preliminary in vitro screening of 17 newly synthesized compounds belonging to the chemical class of N1-(aryliden)-2-pyridinecarboxyamidrazones, active against Mycobacterium tuberculosis H37Rv, the minimum inhibitory concentrations (MICs) of the ten most promising agents against three clinical isolates were determined by agar dilution. Compounds 12 and 14 were the most active, each inhibiting strain H37Rv at concentrations of 8 microg/ml and having a MIC of 16 microg/ml against the human isolates. The results obtained in this preliminary study confirmed the interesting antitubercular properties of these newly synthesized compounds and allowed us to carry out our investigations over a large number of isolated clinical strains.

Alkaline phosphatase and gamma glutamyltranspeptidase in human lymphomas.

Alkaline phosphatase (AP) and gamma glutamyltranspeptidase (GGT) were studied in normal lymphoid cells and in 28 cases of human lymphomas (23 of non-Hodgkin's and 5 of Hodgkin's disease). The expression of AP was enhanced in several samples with a high proportion of mature B cells, particularly in centroblastic-centrocytic lymphoma, whereas tissues mainly composed of T cells always showed low levels of this enzyme. GGT levels were high in thymus, as well as in centroblastic-centrocytic lymphoma and other NHL, thus demonstrating no restriction to a particular cell lineage. Some B-cell neoplasms with cellular origin different from that of centroblastic-centrocytic lymphoma, such as chronic lymphocytic leukemia and centrocytic lymphoma, had low levels of both enzymes. The role of investigation with specific antibodies against these two enzymatic activities in the physiology of lymphoma cell membrane is discussed.

Synthesis and antimycobacterial activity of some indole derivatives of pyridine-2-carboxamidrazone and quinoline-2-carboxamidrazone.

A series of pyridine-2-carboxamidrazone and quinoline-2-carboxamidrazone derivatives containing the indole moiety was prepared. Some of the synthesized compounds showed an interesting in vitro antimycobacterial activity against a strain of Mycobacterium tuberculosis.

Synthesis and antimicrobial activity of some 2,5-disubstituted 1,3,4,-thiadiazole derivatives.

A series of 5-substituted 2-arylamino-1,3,4-thiadiazole derivatives was prepared. The antimicrobial activity of these compounds against some strains of bacteria and a strain of Candida albicans was determined, together with that of the corresponding thiosemicarbazone derivatives, which are intermediates in the synthetical procedure.

Synthesis and antimycobacterial activity of some 4H-1,2,4-triazin-5-one derivatives.

6-[(Arylmethylenamino)carbonyl]-3-(pyridin-2-yl)-4H-1,2,4-triazin-5-one derivatives were synthesized and tested for their in vitro antimycobacterial activity. Some compounds showed interesting activity against a strain of Mycobacterium tuberculosis.

Synthesis and antimycobacterial activity of [5-(pyridin-2-yl)-1,3,4-thiadiazol-2-ylthio]acetic acid arylidene-hydrazide derivatives.

[5-(Pyridin-2-yl)-1,3,4-thiadiazol-2-ylthio]acetic acid arylidene-hydrazide derivatives were synthesized and tested for their in vitro antimycobacterial activity. Some compounds showed a feable activity against a strain of Mycobacterium tuberculosis and a strain of Mycobacterium avium.

Synthesis and antimycobacterial activity of 5-aryl-1-isonicotinoyl-3-(pyridin-2-yl)-4, 5-dihydro-1H-pyrazole derivatives.

5-Aryl-1-isonicotinoyl-3-(pyridin-2-yl)-4,5-dihydro-1H-pyrazole derivatives were synthesized and tested for their in vitro antimycobacterial activity. The compounds showed an interesting activity against a strain of Mycobacterium tuberculosis and a human strain of M. tuberculosis H4.

Synthesis and antimycobacterial activity of some N1-[1-[3-aryl-1-(pyridin-2-, 3-, or 4-yl)-3-oxo]propyl]-2- pyridinecarboxamidrazones.

N1-[1-[3-aryl-1-(pyridin-2,3-, and 4-yl)-3-oxo[propyl]-2- pyridinecarboxamidrazone derivatives were synthesized and tested for their in vitro antimycobacterial activity. Some compounds showed interesting activity against a strain of Mycobacterium tuberculosis and a strain of Mycobacterium avium.

Synthesis and antimycobacterial activity of some 4-pyridinecarboxyamidrazone derivatives.

A series of N1-aryliden-4-pyridinecarboxyamidrazone derivatives was prepared. Some of the synthesized compounds showed interesting in vitro antimycobacterial activity against some strains of Mycobacterium and clinical isolates of Mycobacterium tuberculosis.

Synthesis and antimycobacterial activity of some 2-pyridinecarboxyamidrazone derivatives.

A series of N1-aryliden-2-pyridincarboxyamidrazone derivatives was prepared. Some of the synthesized compounds showed interesting in vitro antimycobacterial activity against some strains of Mycobacterium and clinical isolates of Mycobacterium tuberculosis.