Use of Ceftolozane-Tazobactam in Patient with Severe Medium Chronic Purulent Otitis by XDR Pseudomonas aeruginosa.

We present a case of a male Italian patient of 66 years with a history of kidney transplantation in treatment with cyclosporine and methylprednisolone. He visited an ENT clinic and was diagnosed as chronic left purulent otitis media. He began at-home antibiotic therapy with poor benefit. On 09/13/18, he was admitted to the hospital "S. Maria "of Terni for persistence of left ear pain and complete hearing loss. Magnetic resonance imaging (MRI) of the brain showed "in correspondence of the petrous rock and the mastoid…presence of flogistic tissue." Auricular swabs and later surgical drainage of the purulent material were performed and both were positive for extensively drug-resistant (XDR) Pseudomonas aeruginosa sensitive only to colistin in absence of synergism with rifampin. The patient underwent antibiotic therapy with ceftolozane-tazobactam, a new generation cephalosporin with anti-Pseudomonas activity and a ß-lactamase inhibitor, that currently is indicated for the treatment of complicated urinary tract infections and complicated intra-abdominal infections, with complete healing. In literature, it is described a series of 12 patients with severe MDR (multidrug-resistant) Pseudomonas aeruginosa infections (6 pneumonia) who received salvage therapy with ceftolozane-tazobactam after inappropriate empirical and/or suboptimal treatment. This study included a case of a male patient of 45 years, affected by Burkitt lymphoma and severe neutropenia, who presented with otitis and mastoiditis, and isolation of Pseudomonas aeruginosa in surgical drainage of the purulent material of the ear (blood cultures were negative). He underwent antibiotic therapy with ceftolozane-tazobactam at a dosage of 3 g/8 h for 21.3 days. The patient was healed, but a late recurrence was described because of isolation of ceftolozane-tazobactam-resistant Pseudomonas after therapy. The possibility of acquiring resistance to ceftolozane-tazobactam should be considered in patients with previous exposure to beta-lactams and with poor response to these antibiotics.

Acetylcholinesterase inhibitors in Alzheimer's disease influence Zinc and Copper homeostasis.

BACKGROUND: Alzheimer's disease (AD) is the most common age-related neurodegenerative disease. An altered homeostasis of Zinc (Zn) and Copper (Cu), as well as a dysregulated expression of Zn-regulatory proteins have been previously described in AD. Acetylcholinesterase inhibitors (AChEI) are commonly used as AD treatment to improve cognitive function, but their effect on Zn homeostasis is still unexplored. OBJECTIVES: The aims of this study were to define the metal dyshomeostasis in AD patients, to investigate AChEI influence on Zn homeostasis and inflammation, and to analyze the relationship between cognitive impairment at two-year follow-up and metal concentrations, considering AChEI use. METHODS AND RESULTS: 84 Healthy Elderly (HE) and 95 AD patients were enrolled (62 AchEI user and 33 AchEI naïve). HE showed similar plasma Zn and Cu concentrations and Cu/Zn ratio in comparison to AChEI users, but significantly higher Zn level, as well as lower Cu amount and Cu/Zn ratio than AChEI naïve patients. Moreover, AChEI users had increased Zn plasma level, reduced Cu amount, Cu/Zn ratio, and IL1ß concentration and lower Zip2 lymphocytic expression vs. naïve patients. A multiple linear regression analysis showed that the MMSE score decline after two-year follow-up was reduced by AChEI therapy and was positively associated with plasma Zn decrease over time. CONCLUSION: Our data revealed that AChEI use may affect peripheral Zn and Cu homeostasis in AD patients, decrease Cu/Zn ratio demonstrating a general reduction of inflammatory status in patients under AChEI treatment. Finally, AChEI influence on circulating Zn could be implicated in the drug-related slowdown of cognitive decline.

Clinical evaluation of TRCReady M.TB for rapid automated detection of M. tuberculosis complex in respiratory samples.

SETTING: Timely diagnosis of tuberculosis (TB) is essential for effectively controlling and managing the disease. Although international guidelines recommend acid-fast bacilli staining and culture as the 'gold standard', new molecular methods are available to safely and rapidly identify positive samples. OBJECTIVE: To evaluate the performance of the newer and fully automated version of a molecular assay for rRNA amplification (TRCReady® M.TB) on 1028 respiratory samples collected from 378 patients for its possible use as a reliable screening method. Results were evaluated using culture as the reference test. RESULTS: Of four diagnostic protocols employed, best results were obtained when TRCReady M.TB was used together with microscopy on the first respiratory sample, followed by microscopy alone on a second one. The sensitivity and specificity were respectively 97% and 100%, with a turnaround time of 24 h. We propose a possible laboratory algorithm for rapid identification of patients with TB. CONCLUSIONS: TRCReady offers the advantages of full automation and avoidance of cross-contamination. As such, it should be considered as a more economical option for TB screening than other commercial assays that are currently available.

My Mind Project: the effects of cognitive training for elderly-the study protocol of a prospective randomized intervention study.

BACKGROUND: Cognitive decline and dementia represent a key problem for public health as they heavily impair social functioning and independent living. The development of new strategies to support recommendations for patients and their caregivers may represent an outstanding step forward. AIMS: To describe the study protocol and methods of "My Mind Project: the effect of cognitive training for elderly" (Grant No. 154/GR-2009-1584108), which investigates, by the use of a multidisciplinary approach, the effects of a comprehensive cognitive training programme on performances in aged subjects with mild-moderate Alzheimer's disease, mild cognitive impairment and normal cognitive functioning. METHODS: The study is a prospective randomized intervention for the assessment of cognitive training effects in three groups of elderly subjects with different cognitive status. A total of 321 elderly people were enrolled in Marche Region, Italy. Each subject was randomly assigned to an experimental group or to a control group. Cognitive performances and biochemical blood markers have also been analysed before cognitive training (baseline), immediately after termination (follow-up 1), after 6 months (follow-up 2) and after 2 years (follow-up 3). DISCUSSION: The results will be useful to identify some efficient programmes for the enhancement of cognitive performance in elderly with and without cognitive decline. CONCLUSION: The application of a non-pharmacological approach in the treatment of elderly with cognitive disorders could have a profound impact on National Health Service.

Management of paediatric maxillofacial fractures: conventional methods and resorbable materials.

AIM: To compare the outcomes between the use of resorbable plates and screws and the conventional methods in children with paediatric maxillofacial fractures. STUDY DESIGN: a retrospective observational study was designed reviewing the clinical records from June 2007 and June 2011. Data collected included aepidemiological data, type of treatment, outcome and satisfaction questionnaire. Descriptive statistics and bivariate analysis were performed. RESULTS: A total of 1122 children (0-17 years old) were studied. Children treated by conventional methods were 912, while children treated by resorbable materials were 210. The frequency of complications during recovery was similar and no statistically significant difference was noted. The satisfaction questionnaire revealed similar percentages of satisfaction, with a high degree of satisfaction. CONCLUSION: Our experience suggests that resorbable devices should be considered as a treatment option, which avoids the need of further surgery to remove metallic fixation, limits hospital spending and increases children's quality of life.

Dietary habits and ageing in a sample of Italian older people.

OBJECTIVES: To analyse dietary habits and explore the role of socioeconomic status in a sample of elderly Italians. STUDY DESIGN: Observational. PARTICIPANTS AND SETTING: 306 elderly subjects aged 65 and over living in the Marche Region (Italy). MEASUREMENTS: Assessment of dietary habits and life-style characteristics using a "Life-style questionnaire". Nutritional data collected by means of a 53-item "Frequency food questionnaire". RESULTS: The study revealed differences in dietary patterns and food consumption. Age was negatively related to all food categories. Some socio-economic characteristics (level of education and economic status) were correlated with consumption of many foods, such ad Fish, Red Meat and Diary products. Between-the-sexes differences were also documented. CONCLUSION: Our findings showed that the nutritional and dietary habits varied greatly within the sample investigated. The mapping of these dietary and nutritional patterns may be of value for future research in elderly populations, particularly those with low educational status and poor economic means. Conclusively, greater promotion of healthy dietary habits should be targeted towards elderly populations.

BMI, life-style and psychological conditions in a sample of elderly Italian men and women.

OBJECTIVES: To identify the relationship among cognitive status, psychological conditions, anthropometric measurements and life-style in a sample of elderly Italian men and women. METHODS: Three hundred and six volunteers for ZINCAGE Project recruited. The sample was made up of healthy older adults living in the Marche Region aged 65 and over. All elderly were given a complete medical, anthropometric assessment, and psycho-social evaluation. RESULTS: Overall, the participants perceived themselves to be in very good or good (22%) or fair (69%) health; only 9% reported a poor health status. The 46% of the sample fell within the normal body mass index (BMI) range, though 38% were overweight, 12% were obese, and only 4% were underweight. In both sexes, BMI significantly decreased with age (p<0.001). BMI was positively associated with performing sedentary activities (r=0.188; p<0.001). Levels of both sedentary (r=0.221; p<0.001) and non-sedentary (r=0.258; p<0.001) leisure activities were positively associated with education level (p<0.05). It was found that lower scores of physical activity were associated to higher scores of Geriatric Depression Scale (r=-0.425; p<0.01), lower scores of Mini Mental State Examination (r=0.266; p<0.001) and higher score of Perceived Stress Scale (r=-0.131; p<0.05). CONCLUSION: Men and women lead different lifestyles and have a different psychological status, with advancing age consequently stressing the need for healthy lifestyle programmes particularly in the case of overweight and obese elderly people.

Cannabinoid agonist WIN55,212 in vitro inhibits interleukin-6 (IL-6) and monocyte chemo-attractant protein-1 (MCP-1) release by rat pancreatic acini and in vivo induces dual effects on the course of acute pancreatitis.

BACKGROUND: Cannabinoids (CBs) evoke their effects by activating the cannabinoid receptor subtypes CB1-r and CB2-r and exert anti-inflammatory effects altering chemokine and cytokine expression. Various cytokines and chemokines are produced and released by rodent pancreatic acini in acute pancreatitis. Although CB1-r and CB2-r expressed in rat exocrine pancreatic acinar cells do not modulate digestive enzyme release, whether they modulate inflammatory mediators remains unclear. We investigated the CB-r system role on exocrine pancreas in unstimulated conditions and during acute pancreatitis. METHODS: We evaluated in vitro and in vivo changes induced by WIN55,212 on the inflammatory variables amylasemia, pancreatic edema and morphology, and on acinar release and content of the cytokine interleukin-6 (IL-6) and chemokine monocyte chemo-attractant protein-1 (MCP-1) in untreated rats and rats with caerulein (CK)-induced pancreatitis. KEY RESULTS: In the in vitro experiments, WIN55,212 (10(-6) mol L(-1)) inhibited IL-6 and MCP-1 release from acinar cells of unstimulated rats and after CK-induced pancreatitis. In vivo, when rats were pretreated with WIN55,212 (2 mg kg(-1), intraperitoneally) before experimentally-induced pancreatitis, serum amylase, pancreatic edema and IL-6 and MCP-1 acinar content diminished and pancreatic morphology improved. Conversely, when rats with experimentally-induced pancreatitis were post-treated with WIN55,212, pancreatitis worsened. CONCLUSIONS & INFERENCES: These findings provide new evidence showing that the pancreatic CB1-r/CB2-r system modulates pro-inflammatory factor levels in rat exocrine pancreatic acinar cells. The dual, time-dependent WIN55,212-induced changes in the development and course of acute pancreatitis support the idea that the role of the endogenous CB receptor system differs according to the local inflammatory status.

Obesity and body mass index (BMI) in relation to life-style and psycho-social aspects.

Obesity is increasing in middle-aged adults and the elderly. This multifactorial phenomenon may have different causes, such as incorrect nutritional and dietary habits, psycho-social aspects and sedentary life-style. It is becoming a serious problem, due also to the world's ageing society. The aim of this study is to provide preliminary results on BMI, life-style and psycho-social aspects in a sample of Italian subjects, which also assesses the relationship between obesity and psychological health. We hypothesize that obesity is related to many factors, such as life-style, behavioral, socio-economic, and psychological aspects. The sample was made up of 107 obese and non-obese subjects, aged 50-74. All participants were given a multidimensional assessment, which included anthropometric, psycho-social and life-style evaluation. As per the protocol a structured life-style questionnaire designed to gather information on anthropometric measurements, socio-economic factors, physical activity, smoking, alcohol and food intake. The Symptom Checklist-90 (SCL-90) for the evaluation of a broad range of psychological problems and symptoms of psychopathology; the Binge Eating Scale (BES) for the assessment of disorders in the eating habits were administered. BMI was associated with age and education, socio-economic status and smoking in both genders. Psychological factors for obesity differed between overweight men and women. In conclusion, obesity and non-obesity appear as two different entities in some aspects. The increase in the prevalence of obesity in elderly subjects could lead to disability and age-related diseases. For this reason, greater insight of the factors related to the development of obesity is required to develop treatment strategies weight-loss prevention programs.

Psychosocial and biochemical interactions in aging: preliminary results from an Italian old sample of "Zincage" project.

The study of the interactions among biological factors and psychosocial conditions is a very innovative field, because data are lacking in the scientific literature. Among biological aspects, zinc is an essential element in the elderly, especially in relation to one of the proteins, such as albumin, involved in zinc transport into the cells. In this study, the aim is the assessment of the interrelationship between albumin value (used as an index of the body zinc status) and some psychosocial dimensions in elderly Italian sample recruited for ZINCAGE project, supported by the European Commission in the "Sixth Framework Programme". Some tests and questionnaires were administered to older people included in the trial: the "life-style questionnaire"; the mini mental state examination (MMSE); the geriatric depression scale (GDS-15 items). On the basis of the Senieur Protocol for gerontological studies, a sample of 291 Italian healthy old subjects has been recruited in Central Italy and divided into 3 age groups: (a) 125 subjects aged from 65 to 74 years, (b) 89 subjects aged from 75 to 84 years, (c) 77 subjects aged >or=85 years (classified like successful old people). No cognitive impairment assessed by MMSE was observed in 67.5% of the sample; 64.0% had GDS score less than 5, indicating no depression, whereas the prevalence of biological albumin deficiency (<3.5 g/dl) found in Italian old people was 21.0%. Sixty one percent of subjects with albumin deficiency displayed higher values of GDS (>or=5). These preliminary results showed an interrelationship among serum albumin value and psychosocial aspects in Italian old population, suggesting that low albumin values may be involved in impaired psychological dimensions.

[Cerebral hemorrhagic infarction caused by tubercular arteritis in HIV positive patient: a case report] / Considerazioni su di un caso di emorragia cerebrale da arterite tubercolare in soggetto HIV-positivo.

A case of cerebral hemorrhagic infarction caused by tubercular arteritis complicating the course of a tubercular meningitis in an HIV-positive patient is described. The atypical clinical course and histopathologic findings of this rare deadly complication of specific meningeal infection are underlined.

Report on an outbreak of trichinellosis in Central Italy.

At the end of 1988 an outbreak of trichinellosis involving 48 persons occurred in a small town in Central Italy, near the Appennine mountains. The epidemic was caused by the ingestion of sausages recently made with wild boar meat. The people affected were mostly relatives and friends of hunters. Trichinella larvae were found in boar meat sausages and in cats fed with raw leftovers and proved to be Trichinella sp. 3 at biochemical typing. This species of parasite is the most frequently isolated species of Trichinella in Italy and other Southern European countries. Clinically the epidemic has shown a typical, uncomplicated febrile course in most patients, but two patients showed signs of cardiac damage and one intense abdominal pain, suggesting an acute abdomen.

Chronic dietary choline influences the permeability of nerve cell membranes as revealed by in vivo Rb+ uptake and release.

The effect of chronic choline supplementation on the in vivo Rb+ uptake and release of rat brain cortical cells was investigated. Adult (11 months old) and old (22 months old) controls as well as old (22 months old) female rats treated with choline (approximately 100 mg/day in the drinking water) by the age of 11 months, were used. All the animals received a daily dose of 30 mg RbCl/100 g body weight for 14 days, given intraperitoneally, half in the morning, half in the evening. After discontinuation of the RbCl treatment, the animals were killed at intervals of 2, 4, 9 and 16 days, respectively. The intracellular Rb+ and K+ contents were analyzed by energy dispersive X-ray microanalysis, whereas concentrations of these two elements were determined by atomic absorption spectrophotometry in the cerebrospinal fluid. Old animals accumulate more Rb+ than the adult ones at any time taken into account. Choline treatment was able to reduce the amount of accumulated Rb+ in the old rats. Rb+-discrimination ratios calculated on the basis of Rb+ and K+ contents of both cortical cells and cerebrospinal fluid, is higher in old rats as compared to both adult and old choline treated rats. Present findings support that chronic choline treatment is effective improving the passive membrane permeability of nerve cells for Rb+ (and K+) in the old animals.

The effect of chronic hydergine treatment on the plasticity of synaptic junctions in the dentate gyrus of aged rats.

The number of synapses (Nv), the surface density of contact zones (Sv) as well as the average size (S) of E-PTA stained synapses in the supragranular layer of the dentate gyrus from adult (12 months), old (30 month), and Hydergine-treated old (30 months) rats were measured by using quantitative morphometric techniques. In old animals, Nv and Sv were significantly reduced, whereas S was significantly increased as compared with the values in adult rats. Hydergine (Codergocrine mesylate) treatment of old animals (3 mg/Kg/day for 4 weeks) influenced these three parameters, differentially. The Sv in aged animals receiving Hydergine, relative to that in untreated old rats, was significantly increased; the number and size of synapses in the treated old rats were significantly higher and smaller, respectively, than that in old controls. We interpret the present findings to indicate a modulating effect of Hydergine on the morphological plasticity of synaptic junctions in the dentate gyrus of aged rats.

Age-related morphological rearrangements of synaptic junctions in the rat cerebellum and hippocampus.

A quantitative investigation has been carried out on the age-related morphological changes of the synaptic junctions in the cerebellar glomeruli and in the supragranular layer of the hippocampal dentate gyrus of young (3 months), adult (12 months) and old (28-30 months) rats. The numerical (Nv) and surface (Sv) density as well as the average length (L) of E-PTA stained synapses was calculated by means of morphometric methods. The results we obtained showed a similar trend in both these areas of the CNS. Nv significantly increased between young and adult rats and significantly decreased in the old group, when compared both to young and adult animals. Sv appeared to be unchanged comparing young and adult animals, whereas it was significantly reduced in the old group. L showed a decrease between 3 and 12 months of age and appeared to be markedly increased in the old animals when compared to adult values. From the present findings it can be inferred that number (Nv) and size (L) of the synapses are in a close inverse relationship which, through the organism's life span, aims to maintain the constancy of the surface contact area (Sv) among the dendritic network. By considering Nv, L and Sv altogether per age group, we were able to obtain a reliable measurement of the morphological aspect of synaptic plasticity through different periods of the life. With regard to aging we found that, despite the 'compensative synaptogenesis' brought about by the increased size (L) of the synaptic appositions, the reactive capacity of old nerve cells is seriously impaired.

Vitamin E deficiency alters the in vivo Rb+ discrimination of rat brain cortical cells.

The in vivo Rb+ uptake and release of rat brain cortical cells of 11-months-old rats fed with a vitamin E deficient diet was investigated. The animals were treated with a daily dose of 30 mg RbCl/100 g body weight for 14 days. After discontinuation of the RbCl treatment the animals were killed at intervals of 2, 4, 9 and 15 days, respectively. The intracellular Rb+ and K+ contents were analyzed by energy dispersive X-ray microanalysis, whereas concentrations of these two ions were determined by atomic absorbtion spectrophotometry in the serum and cerebrospinal fluid. Vitamin E deficient rats accumulate more Rb+ than age-matched normally fed animals at any time taken into account. Rb+-discrimination ratios calculated on the basis of Rb+ and K+ contents of both, cortical cell cytoplasm and cerebrospinal fluid, are higher in vitamin E deficient rats than in the controls (+20%), which supports the view that the enhanced membrane lipid peroxidation induced by vitamin E deficiency impairs the passive membrane permeability for Rb+ (and K+).

Quantitative investigation of the morphological plasticity of synaptic junctions in rat dentate gyrus during aging.

The morphological plasticity of synaptic junctions was investigated by means of quantitative stereology in the dentate gyrus supragranular layer of young (3 months), adult (12 months) and old (30 months) female Fisher 344 rats. The numerical (Nv) and surface (Sv) density and the average surface area (S) of EPTA-stained synaptic junctions were calculated on 100 EM pictures per age group. We found that Nv significantly increased between the young and adult group and decreased in old animals when compared both to 3 and 12 months of age. Sv was unchanged in young and adult rats, whereas it underwent a significant reduction in the old group. The percentage distribution of S showed that at 3 months of age the majority of the synaptic population had an average size ranging between 0.12 and 0.20 micron 2, whereas during adulthood and aging there was a shift towards smaller and larger synaptic contacts, respectively. Taking into account Nv, Sv and S all together per age group, the present findings demonstrate that the morphological aspect of synaptic plasticity is markedly influenced by time and that during aging it undergoes a serious impairment. The possible involvement in memory and learning processes of these synaptic age-related morphological adaptations and the fact that the investigated junctions are supposed to be cholinergic is discussed.

Chronic dietary choline modulates synaptic plasticity in the cerebellar glomeruli of aging mice.

A morphometric investigation was carried out on ethanolic phosphotungstic acid (E-PTA) stained synaptic junctions in the cerebellar glomeruli of adult, old, old choline-deficient and old choline-supplemented mice. Numerical (Nv) and surface (Sv) density as well as average length (L) of the synapses were calculated on 100 pictures per group. A significant reduction of Nv and Sv, as well as an increase of L was found during aging. Choline deficient animals did not show any change as compared to old animals of the same age. In choline supplemented mice Nv and Sv were significantly increased and L significantly decreased, respectively, as compared to old control littermates. No difference was found between adult and choline supplemented mice. In the cerebellar glomeruli only a small fraction of fibers are cholinergic, therefore the present findings support the idea that dietary choline can influence systems other than cholinergic. The possible role of choline supplementation in the modulation of synaptic plasticity via the synthesis and/or turnover of neuronal membrane choline phospholipids, is discussed.

Amiloride inhibits the PHA-evoked mouse splenic lymphocyte proliferation.

The present study was aimed to ascertain whether Na+ influx can be involved in regulation of blastogenesis and proliferation of PHA stimulated mouse splenic lymphocytes. The cells were cultivated in the presence of different concentrations of amiloride, an inhibitor of passive Na+ influx, and cellular activation was monitored by 3H-thymidine incorporation and blast index determination. The drug was not toxic and inhibited cell growth in concentrations ranging from 1 X 10(-3) to 1 X 10(-5) mmol/ml. The results are in agreement with the hypothesis that Na influx is necessary for PHA evoked mouse splenic lymphocyte activation.

A modulating effect of Hygergine on the synaptic plasticity of old rats.

The morphological plasticity of E-PTA stained synaptic junctions was investigated by means of quantitative morphometry in the dentate gyrus supra-granular layer of adult, old and old-Hydergine treated rats. Numerical (Nv) and surface (Sv) density as well as average size of the synapses (S) were the three parameters considered. During aging, Nv and Sv significantly decrease whereas S increases. Hydergine treatment to old rats resulted in a significant increase of Nv and Sv and a significant decrease of S. Present findings are interpreted as a modulating effect of Hydergine on the synaptic plasticity of old rats.