What's growing on General Practitioner's stethoscope?

BACKGROUND: Non-critical medical devices, as stethoscopes, have long been considered as vectors in microorganisms' transmission. Cleaning standards for non-critical medical equipment are often unclear. This study was designed to assess the attitude of General Practitioners (GPs) towards cleaning their stethoscope and the degree of microbiological contamination of doctor's instrument in outpatient setting. STUDY DESIGN: Observational, crossover study. METHODS: A structured questionnaire was administered to GPs to test their knowledge about medical instrument's cleanliness recommendations and the surface of the diaphragm of their stethoscopes was analyzed for bacteriological isolates using mass spectrometry technique. RESULTS: Most of GPs declared they don't know cleaning recommendations for non-critical medical devices and a relevant bacterial growth was identified on the majority of the stethoscopes' membranes. Almost all microbiological isolates resulted typically found in cutaneous flora. CONCLUSIONS: We can't state that the GP's stethoscopes feature a risk of transmission for microbiological pathogens; anyway, because of the level of contamination we observed, cleaning recommendations to disinfect instruments on a regular basis should be better indicated.

Early molecular diagnosis of aspergillosis in a patient with acute myeloid leukaemia.

Diagnosis of invasive fungal infection remains challenging. Here we report a case of early diagnosis of invasive aspergillosis in a neutropenic patient affected by acute myeloid leukaemia, achieved through the detection of Aspergillus fumigatus species-specific ribonucleic acid sequences by a sensitive multiplex real-time polymerase chain reaction-based molecular assay. Thanks to the early diagnosis, targeted therapy was promptly established and the severe fungal infection controlled, allowing the patient to subsequently receive allogeneic hematopoietic stem cell transplantation from a haploidentical donor, her only curative option. Also in this instance, targeted secondary antifungal prophylaxis with voriconazole avoided any other fungal infection afterwards. This report suggests how the implementation of molecular assays in combination with routine diagnostic procedures, can improve microbiological diagnosis in sepsis, particularly in case of fungal infection, difficult to detect with standard microbiological culture methods.

Brain arteriovenous malformations and seizures: an Italian study.

OBJECTIVE: To evaluate seizures as first clinical manifestation of brain arteriovenous malformations (AVMs), in relation to angioarchitectural features of these vascular anomalies. METHODS: We performed a prospective observational study, collecting records of patients with AVMs consecutively admitted to the Neurological and Neurosurgery Units of Perugia University and to the Neurosurgery Unit of Terni Hospital, during a 10-year period (1 January 2002 to 1 June 2012). Two groups of patients, with or without seizures as AVM first presentation, were analysed to identify differences in demographic and angiographic features. A multivariate logistic regression model was also developed. RESULTS: We examined 101 patients with AVMs, 55 male and 46 female. Seizures were the initial clinical manifestation in 31 (30.7%) patients. We found a significant difference (p<0.05) between two groups of patients, with or without seizures as AVM first presentation concerning location, side, topography and venous drainage. A multivariate logistic regression model showed that clinical presentation with seizures was correlated with a location in the temporal and frontal lobes, and with a superficial topography. The strongest association (OR 3.48; 95% CI 1.77 to 6.85) was observed between seizures and AVM location in the temporal lobe. CONCLUSIONS: Vascular remodelling and haemodynamic changes of AVMs might create conditions for epileptogenesis. However, here we show that malformations with specific angiographic characteristics are more likely to be associated with seizures as first clinical presentation. Location is the most important feature related to epilepsy and in particular the temporal lobe might play a crucial role in the occurrence of seizure.

A juvenile case of cerebellar arteriovenous malformation with gradual onset of dysphoria and headache.

A 25-year-old woman was admitted because of frequent vomiting and headache which had lasted over one week. She had initially clear consciousness but slowly progressive mild headache and dysphoria. Emergency cranial CT revealed a 4 cm haematoma in the left cerebellar hemisphere. CT angiography showed a 2×2 cm nidus of an arteriovenous malformation (AVM) in the left hemisphere fed from the left posterior inferior cerebellar artery and draining into the inferior hemispheric vein. We performed a surgical resection of the AVM after decompression therapy to counteract the brain oedema. She recovered completely without any neurological deficits. This case recalls the importance of cooperation between diagnostic neuroradiology and neurosurgery in emergency, considering AVM, even if infrequent, among possible diseases.

Pure surgical treatment of 109 aneurysms.

AIM: Target of this study was to investigate outcomes after pure surgical treatment of intracranial aneurysms. METHODS: Patients with intracranial supratentorial circle aneurysms were retrospectively reviewed between July 1994 and October 1998. Studied cases were admitted at the Department of Neurosurgery of S. Maria-Hospital, Terni, a Government supported General Hospital. One hundred and nine Hunt and Hess Grade 0 to III patients with supratentorial circle aneurysms was studied in order to determine whether advances in the surgical management of intracranial aneurysms have improved surgical outcomes and which factors may predict outcome. All patients were managed only with standard neurosurgical aneurysms clipping procedures. Outcomes evaluation was made at patients' discharge and classified on the base of the Glasgow Outcome Scale (GOS). Surgical timing, SAH grading, pre and post surgical symptomatic vasospasm, temporary clipping, and intraoperative aneurysm rupture were correlated with outcomes. RESULTS: Surgical results showed a 75% excellent outcome. Mortality rate was 3%. Hunt and Hess grade 0 highly influenced outcome. Differences in outcomes among grades I to III were not significant. No differences in outcomes related to temporary clipping were noted. A low rate of intraoperative aneurysm rupture is reported: 5 out of 109 cases. In all these cases outcome was good, with neither mortality or morbidity. CONCLUSIONS: Results indicate a progressive improvement in surgical outcomes, suggesting that there still exist margins for improvements in pure surgical management of intracranial aneurysms.

Phage display for the production of human monoclonal antibodies against human pathogens.

In the last decade an increasing number of antibodies have made their way from the research benchtops into the clinics and many more are currently under clinical trial. Among monoclonal antibody-producing techniques, phage-display is undoubtedly the most effective and versatile. Cloning of the entire humoral repertoire derived from an infected patients into a phage display vector allows not only the simple generation of monoclonal antibodies of desired specificity, but also the molecular dissection of the antibody response itself. Generation of large panels of human monoclonal antibodies against human pathogens could open new perspectives in understanding the interplay between the infectious agent and the infected host providing tools for the prevention and the therapy of human communicable diseases. In this paper the basic principles of the phage-display approach as well as its most recent applications are reviewed.

Humoral immune response against hepatitis C virus.

Antibodies are in several instances a reliable marker indicating vigorous immune response against infectious agents and in several viral diseases presence in the blood of specific anti-viral antibodies indicates an effective protection. However, this is not always true. For example, in the case of hepatitis C virus (HCV) an important human pathogen considered the causative agent of the nonA- nonB hepatitis, in spite of an intense antibody response there is no protection against a new infection and in the majority of infected individuals the virus overcomes host defences establishing a persistent infection. Here we describe how the dissection of the humoral immune response against HCV glycoprotein E2 of infected patients was useful for a better comprehension of the virus-host interplay. Cross-reactive antibodies directed against E2 are produced by the HCV-infected patient, but not all of them are protective, and some could even result to be detrimental for the patient. The cross-reactive anti-HCV/E2 humoral antibody response is complex and not necessarily completely beneficial to the host.

Heterogeneity of the humoral anti-HCV/E2 response in persistently infected patients as demonstrated by divergent patterns of inhibition of the binding of anti-HCV/E2 human monoclonal antibodies.

A complete understanding of the molecular features of humoral immune response could be of pivotal importance in the management of persistent viruses as HCV. In this study, 24 HCV-positive samples, characterized by classical virological parameters, are evaluated using a new assay for the quantitation of antibody subpopulations directed against discrete epitopes on surface glycoprotein E2, a key viral protein. The results, besides confirming the usefulness of this new approach, highlight the extreme heterogeneity of anti-HCV/E2 response as far as single epitopes are concerned. The specific epitopes under study are also demonstrated to be widely shared among different genotypes.

Intraneural capillary hemangioma of the cauda equina.

A case of intraneural capillary hemangioma involving the dorsal root of a spinal nerve of the cauda equina is reported. The patient was a 41-year-old man with a 3-month history of intermittent left lumbosciatalgia. MRI and CT myelography showed a space-occupying mass at the level of the cauda equina. Laminectomy of L5 and complete removal of the lesion were performed without neurological problems. The clinical, diagnostic, and therapeutic aspects of hemangiomas of the cauda equina are analyzed.

Cervical spontaneous epidural hematoma as a complication of non-Hodgkin's lymphoma.

Epidural hematoma is a rare cause of spinal cord compression, which usually provokes severe neurological deficits. It is presumed to originate from venous or, more probably, arterial bleeding. Thrombocytopenia and other disorders of coagulation may precipitate the onset of epidural hematoma and facilitate the evolution of the disease. We report the case of a patient suffering from a non-Hodgkin's lymphoma with severe thrombocytopenia during a MACOP-B schedule, who presented with a spontaneous cervical epidural hematoma. We discuss the etiopathological aspects, diagnosis, and treatment of this rare cause of acute cervical spinal cord compression.

[Production of xanthan gum in immobilized cultures of Xanthomonas campestris]. / Producción de goma xántica en cultivos inmovilizados de Xanthomonas campestris.

The efficiency of xanthan production through surface processes was evaluated. The best porous material was selected first. Thereafter, a comparative study was performed using submerged agitated process vs other without agitation but containing the selected porous material. The culture medium used was white potatoes infusion, buffered with K2HPO4 and supplemented with glucose in diverse concentrations. Besides, to evaluate a different type of surface process, three vegetables were valued: Ipomaea batatus, Solanum tuberosum and Daucus carota, with an without glucose supplement. Larger xanthan production was achieved with immobilization of X. campestris vs the conventional method, when the liquid culture medium was used. The highest yield was obtained when the white potatoes infusion was supplemented with glucose 2.5%, yielding a conversion of this saccharide to xanthan up to 58%. When X. campestris was cultured on fragmented vegetables, the highest xanthan gum yield (5.6g) was obtained with Solanum tuberosum supplemented with glucose. This yield indicators that X. campestris used the glucose added as well as the constitutive polysaccharide of this vegetable.

Producción de goma xántica en cultivos inmovilizados de Xanthomonas campestris. / [Production of xanthan gum in immobilized cultures of Xanthomonas campestris]

The efficiency of xanthan production through surface processes was evaluated. The best porous material was selected first. Thereafter, a comparative study was performed using submerged agitated process vs other without agitation but containing the selected porous material. The culture medium used was white potatoes infusion, buffered with K2HPO4 and supplemented with glucose in diverse concentrations. Besides, to evaluate a different type of surface process, three vegetables were valued: Ipomaea batatus, Solanum tuberosum and Daucus carota, with an without glucose supplement. Larger xanthan production was achieved with immobilization of X. campestris vs the conventional method, when the liquid culture medium was used. The highest yield was obtained when the white potatoes infusion was supplemented with glucose 2.5

, yielding a conversion of this saccharide to xanthan up to 58

. When X. campestris was cultured on fragmented vegetables, the highest xanthan gum yield (5.6g) was obtained with Solanum tuberosum supplemented with glucose. This yield indicators that X. campestris used the glucose added as well as the constitutive polysaccharide of this vegetable.

Producción de goma xántica en cultivos inmovilizados de Xanthomonas campestris. / [Production of xanthan gum in immobilized cultures of Xanthomonas campestris]

The efficiency of xanthan production through surface processes was evaluated. The best porous material was selected first. Thereafter, a comparative study was performed using submerged agitated process vs other without agitation but containing the selected porous material. The culture medium used was white potatoes infusion, buffered with K2HPO4 and supplemented with glucose in diverse concentrations. Besides, to evaluate a different type of surface process, three vegetables were valued: Ipomaea batatus, Solanum tuberosum and Daucus carota, with an without glucose supplement. Larger xanthan production was achieved with immobilization of X. campestris vs the conventional method, when the liquid culture medium was used. The highest yield was obtained when the white potatoes infusion was supplemented with glucose 2.5

, yielding a conversion of this saccharide to xanthan up to 58

. When X. campestris was cultured on fragmented vegetables, the highest xanthan gum yield (5.6g) was obtained with Solanum tuberosum supplemented with glucose. This yield indicators that X. campestris used the glucose added as well as the constitutive polysaccharide of this vegetable.

Producción de goma xántica en cultivos inmovilizados de Xanthomonas campestris / [Production of xanthan gum in immobilized cultures of Xanthomonas campestris]

The efficiency of xanthan production through surface processes was evaluated. The best porous material was selected first. Thereafter, a comparative study was performed using submerged agitated process vs other without agitation but containing the selected porous material. The culture medium used was white potatoes infusion, buffered with K2HPO4 and supplemented with glucose in diverse concentrations. Besides, to evaluate a different type of surface process, three vegetables were valued: Ipomaea batatus, Solanum tuberosum and Daucus carota, with an without glucose supplement. Larger xanthan production was achieved with immobilization of X. campestris vs the conventional method, when the liquid culture medium was used. The highest yield was obtained when the white potatoes infusion was supplemented with glucose 2.5

, yielding a conversion of this saccharide to xanthan up to 58

. When X. campestris was cultured on fragmented vegetables, the highest xanthan gum yield (5.6g) was obtained with Solanum tuberosum supplemented with glucose. This yield indicators that X. campestris used the glucose added as well as the constitutive polysaccharide of this vegetable.

Producción de goma xántica en cultivos inmovilizados de Xanthomonas campestris / [Production of xanthan gum in immobilized cultures of Xanthomonas campestris]

The efficiency of xanthan production through surface processes was evaluated. The best porous material was selected first. Thereafter, a comparative study was performed using submerged agitated process vs other without agitation but containing the selected porous material. The culture medium used was white potatoes infusion, buffered with K2HPO4 and supplemented with glucose in diverse concentrations. Besides, to evaluate a different type of surface process, three vegetables were valued: Ipomaea batatus, Solanum tuberosum and Daucus carota, with an without glucose supplement. Larger xanthan production was achieved with immobilization of X. campestris vs the conventional method, when the liquid culture medium was used. The highest yield was obtained when the white potatoes infusion was supplemented with glucose 2.5

, yielding a conversion of this saccharide to xanthan up to 58

. When X. campestris was cultured on fragmented vegetables, the highest xanthan gum yield (5.6g) was obtained with Solanum tuberosum supplemented with glucose. This yield indicators that X. campestris used the glucose added as well as the constitutive polysaccharide of this vegetable.