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.

Checking rounds for isolation precautions in the control of multidrug-resistant organisms: reduction achieved.

The objective of this investigation was to analyze the effectiveness of a quality improvement initiative in limiting the spread of multidrug-resistant organisms (MDROs) in the hospital setting. During the period 2011-2013, a multimodal intervention was activated at a tertiary care center in Italy. The intervention included: laboratory-based surveillance, interdisciplinary training sessions, monitoring the adoption of isolation precautions and daily supervision provided by infection control nurses, and a monthly feedback. Time series analysis was used to evaluate the trends and correlations between the MDROs rate, intensity of checking rounds, and hospital-wide data (i.e., transfer of patients, patients' days, site of isolation, etc.). A total of 149,251 patients were included in the study. The proportion of patients undergoing transmission-based isolation precautions within 24 h from a positive laboratory finding increased from 83% in 2011 to 99% in 2013 (p < 0.05). The wards appropriately adopting the correct isolation precaution increased from 83% in 2011 to 97.6% in 2013 (p < 0.05). The frequency of controls was significantly reduced after the observation of compliance in the appropriate wards (p < 0.05). After three years, the incidence rate changed from 5.8/1000 days of stay [95% confidence interval (CI) 5.6-6.1] in 2011 to 4.7 (95% CI 4.4-4.9) in 2013 (p < 0.0001). Moreover, microorganisms isolated from different types of specimens showed variable potential for transmission (i.e., skin as the most potential and urine the least). The results demonstrate the efficacy of the multimodal intervention, with sustained reduction of MDROs rate, besides check reduction, and highlight the long-term efficacy of checking rounds in changing professionals' behaviors.

Prognostic value of brain proton MR spectroscopy and diffusion tensor imaging in newborns with hypoxic-ischemic encephalopathy treated by brain cooling.

INTRODUCTION: MRI, proton magnetic resonance spectroscopy (¹H-MRS), and diffusion tensor imaging (DTI) have been shown to be of great prognostic value in term newborns with moderate-severe hypoxic-ischemic encephalopathy (HIE). Currently, no data are available on ¹H-MRS and DTI performed in the subacute phase after hypothermic treatment. The aim of the present study was to assess their prognostic value in newborns affected by moderate-severe HIE and treated with selective brain cooling (BC). METHODS: Twenty infants treated with BC underwent conventional MRI and (1)H-MRS at a mean (SD) age of 8.3 (2.8) days; 15 also underwent DTI. Peak area ratios of metabolites and DTI variables, namely mean diffusivity (MD), axial and radial diffusivity, and fractional anisotropy (FA), were calculated. Clinical outcome was monitored until 2 years of age. RESULTS: Adverse outcome was observed in 6/20 newborns. Both ¹H-MRS and DTI variables showed higher prognostic accuracy than conventional MRI. N-acetylaspartate/creatine at a basal ganglia localisation showed 100% PPV and 93% NPV for outcome. MD showed significantly decreased values in many regions of white and gray matter, axial diffusivity showed the best predictive value (PPV and NPV) in the genu of corpus callosum (100 and 91%, respectively), and radial diffusivity was significantly decreased in fronto white matter (FWM) and fronto parietal (FP) WM. The decrement of FA showed the best AUC (0.94) in the FPWM. CONCLUSION: Selective BC in HIE neonates does not affect the early and accurate prognostic value of ¹H-MRS and DTI, which outperform conventional MRI.

The effect of gestational age on developmental outcomes: a longitudinal study in the first 2 years of life.

BACKGROUND: Extremely low and very low gestational age (ELGA and VLGA) constitutes a risk factor for development even in absence of cerebral damage, as an immature central nervous system is exposed to invasive and inadequate stimulation. We tested the hypothesis that GA impacts developmental outcomes and trajectories of preterms without major cerebral damage in the first 2 years of life, expecting poorer developmental outcomes and higher rate of impairment with the decreasing of GA. We also evaluated whether GA, together with developmental outcomes in the first year of life, was related to developmental outcomes at 24 months. METHODS: Eighty-eight infants, divided into three GA groups (ELGA: ≤28 weeks; VLGA: 29-32 weeks; full term: >37 weeks) were assessed longitudinally at 6, 12, 18 and 24 months using the Griffiths Mental Development Scales. RESULTS: Use of a repeated measure multivariate analysis of variance resulted in several significant findings. GA was associated with the developmental quotient (DQ) scores (P= 0.006); and locomotor (P < 0.001), eye and hand co-ordination (P= 0.016) and performance (P= 0.040) sub-scale quotient (SQ) scores; age of evaluation was also associated with DQ scores (P= 0.002), and locomotor (P < 0.001) and performance (P < 0.001) SQ scores. In particular, ELGAs exhibited lower DQ and SQ scores compared with the VLGA and full-term groups; some ELGAs showed mild, moderate or severe cognitive impairments, while few VLGAs mild impairments. Linear regression analysis showed that GA (P= 0.034) and 12-month developmental outcome (P < 0.001) were related to 24-month developmental outcome. CONCLUSIONS: Different developmental trajectories emerged in relation to GA, with poorer developmental outcomes and higher rates of impairment in ELGAs and few mild impairments in VLGAs. The relevance of taking into account both GA and repeated assessments in the first 2 years of life was shown.

Extended-spectrum beta-lactamases Klebsiella pneumoniae: multimodal infection control program in intensive care units.

INTRODUCTION: The aims of our study were to investigate a nosocomial spread of an extended-spectrum fl-lactamases-Klebsiella pneumoniae cluster at a University teaching hospital in Italy, to describe, and to monitor the implementation of a multimodal infection control program in two mixed ICUs. METHODS: During the 1 October 2005-30 September 2006 period, 79 colonized patients have been identified. Isolates were genotyped by pulsed-field gel electrophoresis (PFGE). A mutimodal infection control program with monitoring of alcohol-based hand rub was performed in Intensive Care Units (ICU A and ICU B). RESULTS: The epidemiological investigation and PFGE showed a horizontal transmission of the same PFGE genotype, with the isolation of the outbreak strain on the hand of one healthcare operator. Alcohol based hand rub was adopted in ICUA on 18 March 2006, in addition to hand washing with plain or antiseptic soap. ICU B did not change its hand hygiene habits. Following the implementation of the program, the incidence density rate (IDR) in ICU A fell down from 4.50 to 1.68/1000 patient days. DISCUSSION AND CONCLUSIONS: Our findings confirm the important role of personnel in cross-transmission. Moreover the inbuilt control group involuntarily offered by the delaying of the intervention in ICU B has given the opportunity to verify the epidemiological association between the actual implementation of infection control practices and the outbreak control.

Quality of life in stroke survivors: first results from the reliability and validity of the Italian version of the Stroke Impact Scale 3.0.

The purpose of this study was to establish the reliability and validity of the Italian version of the Stroke Impact Scale 3.0 (SIS 3.0), a specific and multidimensional instrument that assesses quality of life (QOL) in stroke survivors. Forty-five patients treated in three Rehabilitation Hospitals of the Lazio Region were included in the study. Patients were assessed using the SIS 3.0, the SF-36, the Barthel Index, the Mini Mental State Examination, the Hospital Anxiety and Depression Scale, the NIH Stroke Scale, the Modified Rankin Scale, and the Instrumental Activities of Daily Living. Results showed good internal consistency of the SIS 3.0 (Cronbach's alpha 0.86-0.98), and a good test-retest reliability (r > 0.70, p < 0.000) except for the Emotion and Social Participation subscales. At the re-test, 15 days after the first administration, SIS 3.0 showed a good responsiveness to change, documenting clinical improvement in stroke survivors. Significant correlations between the other instruments and the SIS 3.0 allowed to establish the concurrent validity of the SIS 3.0. Although the small sample size the Italian version of the SIS 3.0 showed good internal consistency and test retest reliability, as well as validity and responsiveness to changes. Since the SIS 3.0 is a specific tool to measure QOL in stroke survivors, its Italian version could be successfully used also in Italian population to better identify predictors of QOL and evaluate the effectiveness of health interventions.

CD30 serum levels and response to hymenoptera venom immunotherapy.

BACKGROUND: The glycoprotein CD30 is expressed and released by T lymphocytes that secrete type 2 helper cytokines of (T(H)2). These molecules play a role in the pathogenesis of allergic diseases. Venom immunotherapy has proven to be very effective in hymenoptera venom allergy through a shift in cytokine production from T(H)2-type cytokines to T(H)1-type cytokines. OBJECTIVE: To evaluate the relationship between the soluble form of CD30 (sCD30) and venom immunotherapy in patients with hymenoptera venom allergy. MATERIALS AND METHODS: sCD30 levels were assayed by enzyme-linked immunosorbent assay in the sera of 61 healthy controls and 14 patients with hymenoptera venom allergy who had undergone immunotherapy before treatment and 1,3, and 12 months after treatment started. Nine patients were allergic to Apis venom, 4 to Vespula venom, and 1 to Polistes venom. RESULTS: CD30 serum levels (median, interquartile range) were significantly higher in venom-allergic patients before treatment (33.6 U/mL; 14.8-61.6) than in controls (9.7 U/mL, 1.9-21.3) (P < .000). These levels decreased progressively during treatment in all patients except 2 (P < .000). At the third month of therapy, the levels reached statistical significance in comparison with baseline. CONCLUSIONS: This study shows that sCD30 levels are significantly higher in patients with hymenoptera venom allergy and indirectly confirms a preferential T(H)2-type cytokine production in these patients. sCD30 expression decreases during immunotherapy, thus confirming the immunomodulatory role of this treatment in promoting a shift to T(H)1-type cytokines.

Hearing threshold estimation by auditory steady state responses (ASSR) in children.

Hearing threshold identification in very young children is always problematic and challenging. Electrophysiological testing such as auditory brainstem responses (ABR) is still considered the most reliable technique for defining the hearing threshold. However, over recent years there has been increasing evidence to support the role of auditory steady-state response (ASSR). Retrospective study. Forty-two children, age range 3-189 months, were evaluated for a total of 83 ears. All patients were affected by sensorineural hearing loss (thresholds ≥ 40 dB HL according to a click-ABR assessment). All patients underwent ABRs, ASSR and pure tone audiometry (PTA), with the latter performed according to the child's mental and physical development. Subjects were divided into two groups: A and B. The latter performed all hearing investigations at the same time as they were older than subjects in group A, and it was then possible to achieve electrophysiological and PTA tests in close temporal sequence. There was no significant difference between the threshold levels identified at the frequencies tested (0.25, 0.5, 1, 2 and 4 kHz), by PTA, ABR and ASSR between the two groups (Mann Whitney U test, p < 0.05). Moreover, for group A, there was no significant difference between the ASSR and ABR thresholds when the children were very young and the PTA thresholds subsequently identified at a later stage. Our results show that ASSR can be considered an effective procedure and a reliable test, particularly when predicting hearing threshold in very young children at lower frequencies (including 0.5 kHz).

An efficient method for culturing human breast epithelium: analysis of results.

We have examined the possibility of obtaining primary cultures from breast tissue utilizing a method especially developed for breast epithelium. The number of specimens able to grow in culture was very high: 82.8%, 64.3%, 75.0% and 77.8%, respectively, for primary breast cancer, skin recurrences, inflammatory breast cancer and normal breast tissue. In our experience, growth was not related to menopausal status or histopathologic type, whereas for skin recurrences, a prior pharmacologic treatment (chemotherapy) of the patient enhanced the growth capacity of the tissue. This culture method could help to study the basic biology of breast epithelia and to improve the chemotherapy approach of breast cancer patients.

In vivo comparative efficacy of three surgical hand preparation agents in reducing bacterial count.

BACKGROUND: Besides objective efficacy, the choice between an antiseptic-based liquid soap, or an alcohol-based hand rub for surgical hand preparation technique is based on personal preference. Glycerol is often added to the formulations in order to enhance tolerability; however, it has been recently reported as a factor reducing the sustained effect of surgical hand rubs. AIM: To compare the efficacies of three commercial products for hand decontamination. METHODS: The in vivo efficacy of an alcohol-based hand rub (isopropyl alcohol 40%; N-propyl alcohol 25%; glycerin 1.74%; triethanolamine salt of carbomer <1%) was compared with other widely used products in surgical hand antisepsis (chlorhexidine and povidone-iodine). All products were used according to the manufacturers' instructions. FINDINGS: The best results were achieved with the alcohol-based hand rub and these were sustained for a period of 3h. Some volunteers experienced skin peeling off the hands when using alcohol-based hand rub; in this group of participants, the bacterial count was reduced only by 0.91 ± 1.67 log10 compared with 2.86 ± 1.22 log10 in the group who did not show this phenomenon. CONCLUSION: Besides confirming the importance of alcohol-based hand rubs for surgical hand decontamination, the results suggest the value of assessing the characteristics, and response of healthcare workers' skin, that may contribute to the development of skin peeling, and the subsequent possibility of a paradoxical overcolonization of hands after surgical preparation with alcohol-based hand rub.

Orofacial pain and Eagle Syndrome: cues from a clinical series.

AIM: Watt Eagle, firstly described the Elongated Stylohyoid Process Syndrome (ESPS), or Eagle Syndrome, in 1937. Since then, several authors have further studied this syndrome and some classifications have been proposed in relation to signs, symptoms and etiopathogenesis. Aim of this paper was to present the clinical features of a cohort of patients affected by Eagle syndrome that underwent surgical treatment. METHODS: Retrospective study. A cohort of ten patients that underwent surgical intervention for Eagle syndrome from January 2000 to December 2012 has been selected. For each subject, medical history, clinical features, treatment and follow-up after surgery were evaluated. RESULTS AND CONCLUSIONS: The surgical treatment resulted effective in 8 of 10 patients. Two patients are still complaining neck pain, although the discomfort has a lower grade and is pharmacologically controllable. Although rare, Eagle's Syndrome should be always considered in the differential diagnosis in patients with chronic orofacial pain refractory to conventional treatments.

[Changes in the bacterial flora of patients under antineoplastic treatment]. / Indagini sulla modificazione della flora batterica in pazienti sottoposti a trattamento antineoplastico.

The bacterial flora of the skin from different anatomical sites on cancer patients and a control group of medical personnel was examined. This was done to ascertain if antineoplastic therapy was able to change the pattern of microbial flora of patients and to provide a control for possible infectious complications. The results show that in the control group bacterial flora was normal and the antineoplastic treatment did not succeed in changing the bacterial pattern in the skin of patients deeply. Gram negative bacteria were isolated more frequently from the skin of leukemia patients than from either patients with malignant melanoma or other neoplastic diseases.

Establishment and characterization of a new cell line from primary human breast carcinoma.

A new cell line (BRC-230) was established from surgical material of primary ductal infiltrating breast carcinoma. The epithelial nature of this cell line was confirmed by ultrastructural analysis and demonstrated the retention of structural properties characteristic of the original tumor. The BRC-230 cell line induced tumor in athymic Cr1:nu/nu(CD-1)BR nude mice, it possessed an abnormal karyotype with a modal chromosome number between 60-61 with eight recurrent marker chromosomes, and it presented a doubling time of 30.5 hr. Scatchard analysis demonstrated that both primary tumor and BRC-230 cells were estrogen and progesterone receptor negative. Immunoenzymatic and radioimmunoassays showed a production of marker antigens (CEA, TPA, CA125, CA15-3, CA19-9) which was similar in the patient's serum and BRC-230 cells. The in vitro drug sensitivity assay of the cell line and of the parental tumor tissue showed overlapping results to all tested antiblastic drugs. BRC-230 cells were resistant to 4-Idroperoxy-cyclophosphamide, Idarubicinol, Mitoxantrone, Etoposide, 4'Epidoxorubicin, and Doxorubicin, showing a multiple drug resistance phenotype. Amplification or rearrangement of Her-2neu, Ha-ras, and C-myc genes was observed neither in the original tumor nor in BRC-230 cells; the mdr-1 gene was also present in a single copy. We conclude from these studies that the BRC-230 cell line maintains the same characteristics as the original tumor and may provide us with a good model to study in vitro the biology of drug resistance of breast cancer.