Screening for Neglected Tropical Diseases and other infections in African refugees and asylum seekers in Rome and Lazio region, Italy.

BACKGROUND: Few reliable data are available on Neglected Tropical Diseases (NTDs) and other infections among African refugees and asylum seekers in Italy. We aimed to estimate the prevalence of NTDs and other infections in a large cohort of African refugees and asylum seekers living in reception centers in Lazio, Italy. MATERIAL AND METHODS: This is an observational, prospective prevalence study on infectious diseases in a large population of African refugees and asylum seekers (936 overall) consecutively enrolled for screening purpose at the Infectious and Tropical diseases outpatient clinic of the National Institute of Migrant and Poverty (INMP), Rome from August 2019 to December 2020. RESULTS: We found a prevalence of 8.8 % and 31 % for Strongyloides and schistosoma infection, respectively, while the prevalence of human immunodeficiency virus (HIV) infection was 0.7 %, HCV antibodies 2.5%, hepatitis B virus surface antigen 10.8 % and syphilis serological tests 2.9 %. CONCLUSION: Strongyloidiasis and schistosomiasis are highly prevalent among African refugees and asylum seekers in Italy, in contrast to communicable diseases (with the exception of hepatitis B). Raising awareness of NTDs among health professionals and implementing guidelines seems to be of paramount importance to prevent these diseases and their sufferers from becoming even more "neglected".

What hides beneath the scar: sexuality and breast cancer what women don't say: A single-center study.

Background: Breast is a symbol of femininity, motherhood and sexuality. Breast cancer (BC) is the leading cause of cancer death in women worldwide and most frequent cancer in Italy: in 2019, 53.500 new cases were diagnosed. BC and its treatment, the disturbances of body image, and mental health problems such as anxiety and depression could influence sexuality. Very often the aspect of sexuality in BC is likely not to be fully investigated: cultural barriers may also contribute to lack of attention to these issues. In Italy, there are very few Breast Units that provide the figure of the sexologist and psycho-oncologist. Methods: We enlisted 141 BC patients (pts), mean age was 54 years afferent to Breast Unit S. Maria Goretti Hospital, Latina, from March 2019 to March 2020. All pts had undergone surgical intervention. Participants were invited to complete a structured questionnaire, which included four close-up questions regarding self-image, sexual activity, sexual satisfaction, analyzing these aspects before and after BC and its treatments. Finally the participants were asked if they needed the sexologist and psycho-oncologist. Results: Only 2/141 pts (1.41%) refused to participate in our study. Of 139 participants, 68 (48.92%) had disturbances of body image, 26 (18.7%) had sexuality greatly negatively affected, and 103 (74.1%) every kind of sexual dissatisfaction after BC. 38 pts (27.3%) would require the help of the sexologist. 135 ( 97%) would require the help of the psycho-oncologist. Despite the negative influence in their body-image and sexuality, few pts require the help of the sexologist, but nearly all pts require the help of the psycho-oncologist. Conclusion: In our study nearly all pts require the help of the psycho-oncologist, but few pts of the sexologist. Further studies will be needed to understand the reasons for this disparity: at the moment we are carrying out another project following this illustration, with the aim of understanding why this disparity.

Effect of electrical water bath stunning on physical reflexes of broilers: evaluation of stunning efficacy under field conditions.

The effects of different amounts and frequencies of stunning sine wave alternating current were investigated under field conditions. Seven hundred and fifty broilers were stunned in an electrical water bath with an average root mean square (RMS) current of 150, 200, and 250 mA and frequencies of 200, 400, 600, 800, and 1,200 Hz. The occurrence of corneal reflex, spontaneous eye blinking, and a positive response to a painful stimulus were monitored and recorded immediately after the stunning and at 20 s post-stun. Statistical analysis showed that the electrical stunning frequency (P=0.0004), the stunning RMS current (P<0.0001) and the interaction between stunning frequency and stunning current (P<0.0001) had a significant effect on the occurrence of animals experiencing an abolition of corneal reflex at 20 s post-stun.At a current of 150 mA, the probability of a successful stun was over 90% at 200 Hz, approximately 40% at 400 Hz, and below 5% for frequencies greater than 600 Hz. So, stunning at frequencies greater than 600 Hz cannot be recommended when a RMS current of 150 mA is applied. The maximum probability of a successful stun was obtained for a current level of 200 mA at 400 Hz and for a current level of 250 mA at 400 and 600 Hz, whereas the stunning treatments at 1,200 Hz provided the lowest probability of a successful stun. Assessment of spontaneous eye blinking and responses to comb pinching confirmed the indications coming from the analysis of corneal reflex.

Levels of Cadmium in White and Brown Meat of Warty Crab (Eriphia verrucosa).

European Union regulations that establish the maximum cadmium (Cd) levels for crab take into account only concentrations found in crab muscle (white meat), mainly from appendages; therefore, other organs and tissues (brown meat) are excluded. The objective of the present study was to evaluate Cd levels in both white and brown crab meat, in order to achieve a more complete assessment of health risk related to human consumption of warty crab. Microwave digestion and atomic absorption spectrometry were used to determine Cd concentrations in warty crab (Eriphia verrucosa) samples collected from the southern Tyrrhenian Sea in Italy. Cd concentrations in all samples of white crab meat were found to be very low (below the limit of quantification), although brown crab meat showed significantly higher Cd concentrations (up to 5.629 mg/kg wet weight; mean value, 1.465 mg/kg). Thus, the consumption of brown meat, common among certain populations of the Mediterranean region, where whole crustaceans are traditionally eaten, substantially increased Cd intake, resulting in alarmingly high estimated weekly intake values.

Salvage treatment with ganciclovir in a splenectomized, polytransfused patient affected by systemic inflammatory response syndrome.

A 23-year-old man was admitted to hospital with a 12-day history of daily fever. A clinical history revealed that 10 months previously, the patient had been splenectomized and polytransfused for a severe blunt trauma. On admission, laboratory data revealed significant leukocytosis (33,230/ul). The patient's general clinical conditions rapidly worsened into a severe systemic inflammatory response syndrome in four days. After 10 days of broad-spectrum antibiotic treatment, the temperature curve was unmodified and severe leukocytosis persisted (44,300 ul) with absolute lymphocytosis. Laboratory tests ruled out hematological diseases, pneumonia, abscesses and endocarditis. In the light of IgM positivity for CMV (unconfirmed by PCR) and with the support of a PubMed search, we commenced a salvage treatment with intravenous ganciclovir, suspecting a viral infection or reactivation. After two days of therapy, an immediate defervescence was observed with a remarkable clinical improvement. After 10 days, the clinical syndrome had been completely resolved and the patient was discharged in good, general clinical health.

Laboratory confirmed bloodstream infection aetiology in an intensive care unit: eight years study.

To evaluate laboratory confirmed bloodstream infection (LC-BSI) aetiology we carried out a prospective study in the general 13 bed ICU of the teaching hospital Policlinico Umberto I in Rome. According to CDC case definitions for LC-BSI, all patients admitted >48h between 2000-2007 to ICU were included. Risk factors (i.e. age, sex, SAPS II), invasive procedures (i.e. endotracheal intubation, vascular and urinary catheterisation), microbiological isolates and their antibiotic susceptibility were screened. Overall 1741 patients (64.8% males, 35.2% females) were included, mean age was 58.1 +/- 19.8, SAPS II score 45.1 +/- 17 and ICU stay 14.0 +/- 21.1 days. Finally, 167 (9.6%) patients developed 203 (11.7%) ICU-acquired LC-BSI and sources of infection were CVC (39.8%), unknown (39.3%), respiratory tract (12.4%), surgical wound (6.5%) and urinary tract (2.0%). Between 2000 and 2007 the incidence of LC-BSI/1000 patient days (14.8 per thousands vs. 7.8 per thousands: p<0.05) and LC-BSI/1000 CVC days (20.7 per thousands vs. 11.4 per thousands; p<0.05) decreased. The onset of infection followed ICU admission by 19.5 +/- 17.7 (mean) and 13 days (median). Crude mortality was 34.8%, and mortality associated with LC-BSI showed a RR 1.61; 95%CI 1.37 - 1.89; p<0.01. The most common pathogens were coagulase negative staphylococci (CNS) (26.2%), methicillin-resistant Staphylococcus aureus (MRSA) (14.9%), Pseudomonas aeruginosa (13.5%), enterococci (9.3%) and Acinetobacter bawnumannii (7.5%). Onset time (days) between ICU admission and LC-BSI was higher (p<0.01) among Gram-negative (22.9 +/- 18.4) compared to Gram-positive (16.6 +/- 15.9), fungi (23.8 +/- 25.3). High early death (<7 days after BSI diagnosis) was associated to A. baumannii (37.5%), Candida spp. (30.0%) and S. aureus (29.7%). Staphylococci presented a very high methicillin resistance (>85%). P. aeruginosa and A. baumannii showed respectively 25% and 68.7% multidrug-resistance. Over 1/3 of Eneterobacteriaceae isolates were extended spectrum beta-lactamase (ESBL), but non resulted resistant to carbapenems. Surveillance showed a high incidence of LC-BSI associated to invasive procedures and the presence of multiresistant bacteria.

Ulcers of the face and neck in a woman with pulmonary tuberculosis: presentation of a clinical case.

INTRODUCTION: Tuberculosis (TB), which is endemic in developing countries, is an important public health problem. Cutaneous TB (CT) represents 1.5% of all TB cases and is considered to be a re-emerging pathology in developing countries due to co-infections with HIV, multidrug-resistant TB, a shortage of health facilities with appropriate diagnostic equipment, reduced access to treatment, and poor treatment compliance among patients who often resort to traditional medicine. CASE REPORT: This report describes the case of a 70 year-old woman who attended the outpatients department of the Italian Dermatological Centre (IDC) in Mekelle, the capital city of Tigray (Northern Ethiopia), complaining of the appearance of two ulcers on her face and neck. The patient had a history of pulmonary TB, with her initial systemic treatment ceased after 1 month. Cytological examination of a needle aspiration from the neck lesion showed a non-specific bacterial superinfection. No acid-fast bacilli were found on Ziehl-Nielsen staining. On the basis of clinical suspicion of CT, it was decided to avoid biopsy for histology and culture and to immediately start anti-tubercular treatment. A significant improvement of the cutaneous lesions was noted after approximately 40 days. CONCLUSION: Currently, the diagnosis of CT is based on careful clinical and histopathological correlation. The standard diagnostic approach is to biopsy for Ziehl-Nielsen stain, culture and histology. However, in rural areas of DC where diagnostic methods may not be available and advanced stages of disease such as CT are likely to be encountered, after the use of the most effective diagnostic tests available, empirical treatment on the basis of medical history and physical examination is suggested. Appropriate training of healthcare workers and public health education programs encouraging early presentation and improved patient treatment compliance are additional important preventative strategies.

[Low colonization with MRSA among health-care workers in an Italian hospital]. / Bassa colonizzazione nasale da MRSA nel personale sanitario di un ospedale romano.

The Authors carried out a study on MRSA colonization rate among health-care workers (HCW) in a large roman hospital. Samples were obtained from staff members at the beginning of each work shift. Two-hundred HCW were included (78 physicians and 122 nurses), mean age 36.6 +/- 10.9 years. We identified 38 (19.0%) S. aureus carriers, prevalently nurses (21.3%) vs. physicians (15.4%). Results showed a RR 2,7; IC95% 1.47-4.86; p < 0.01 among men vs. women. Overall three (1.5%) MRSA strains were isolated among HCW (two nurses and one physician). None of them was a CA-MRSA. The study suggests that HCW act principally as cross transmission vectors and not as main sources of MRSA.

Nevirapine plasma exposure affects both durability of viral suppression and selection of nevirapine primary resistance mutations in a clinical setting.

The relationship between nevirapine plasma concentrations and the durability of both viral suppression (VS) and selection of nevirapine primary resistance mutations (PRMs) was evaluated. A nevirapine trough concentration (Ctrough) of >4,300 ng/ml was found to predict longer VS. Patients with nevirapine Ctrough s ranging from 3,100 to 4,300 ng/ml had higher probabilities of developing PRMs than those with nevirapine Ctrough s below and above this concentration interval.

Clinical pharmacology of antiretroviral therapy.

Antiretroviral therapy represents by all means a new branch of anti-infective chemotherapy, and in order to describe the mode of action of antiretrovirals, a series of inferences from anti-bacterial chemotherapy were made. The currently available antiretroviral agents can be classified as time-dependent drugs, and therefore the key pharmacokinetic parameter adopted in their clinical-pharmacological assessment is the concentration at the end of the dosing interval (Ctrough). By focusing on this parameter, the application of Therapeutic Drug Monitoring (TDM) allows for the successful individual tailoring of the drug dosage in some clinical circumstances, such as treatment of drug-resistant infections, drug-drug interactions and side effects. While this procedure has now been sufficiently standardized for protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), no clinical applications are yet recognized for nucleoside/nucleotide reverse transcriptase inhibitors (N/NtRTIs) and fusion inhibitors. The main unfavourable peculiarity of HIV infection, such as the need for lifelong treatment, is one of the reasons why increasing attention is being paid to pharmacological aspects of antiretroviral therapy. Issues like treatment potency, maintenance over time of the immunovirological benefit and long-term side effects require intensive pharmacological investigation in order to obtain the information on which basing the most convenient strategy to be adopted for the therapeutical management of this condition.

[A simple method to detect disaccharides deficiency]. / Métodos simples de detección de deficiencias de disacaridasas.

A simple method, easy to perform during an endoscopic procedure, fast and inexpensive, that allows detecting deficiencies in lactase, sucrase or maltase activities is presented. Briefly, method consists in placing a duodenal biopsy sample in an adequate vial containing lactose, sucrose or maltose solution during a few minutes, and then, adding a few drops of a glucose reactive from commercial origin. Presence of any enzymatic activity is demonstrated when released glucose from any of the disaccharides chosen reacts with the second reactive, turning solution to a red colour. Its utility is discussed and compared with other diagnostic methods.

Métodos simples de detección de deficiencias de disacaridases / A simple method to detect disaccharides deficiency

A simple method, easy to perform during an endoscopic procedure, fast and inexpensive, that allows detecting deficiencies in lactase, sucrase or maltase activities is presented. Briefly, method consists in placing a duodenal biopsy sample in an adequate vial containing lactose, sucrose or maltose solution during a few minutes, and then, adding a few drops of a glucose reactive from commercial origin. Presence of any enzymatic activity is demonstrated when released glucose from any of the disaccharides chosen reacts with the second reactive, turning solution to a red colour. Its utility is discussed and compared with other diagnostic methods.

Métodos simples de detección de deficiencias de disacaridasas. / [A simple method to detect disaccharides deficiency]

A simple method, easy to perform during an endoscopic procedure, fast and inexpensive, that allows detecting deficiencies in lactase, sucrase or maltase activities is presented. Briefly, method consists in placing a duodenal biopsy sample in an adequate vial containing lactose, sucrose or maltose solution during a few minutes, and then, adding a few drops of a glucose reactive from commercial origin. Presence of any enzymatic activity is demonstrated when released glucose from any of the disaccharides chosen reacts with the second reactive, turning solution to a red colour. Its utility is discussed and compared with other diagnostic methods.

Métodos simples de detección de deficiencias de disacaridases / A simple method to detect disaccharides deficiency

A simple method, easy to perform during an endoscopic procedure, fast and inexpensive, that allows detecting deficiencies in lactase, sucrase or maltase activities is presented. Briefly, method consists in placing a duodenal biopsy sample in an adequate vial containing lactose, sucrose or maltose solution during a few minutes, and then, adding a few drops of a glucose reactive from commercial origin. Presence of any enzymatic activity is demonstrated when released glucose from any of the disaccharides chosen reacts with the second reactive, turning solution to a red colour. Its utility is discussed and compared with other diagnostic methods. (AU)

Dying, mourning, and spirituality: a psychological perspective.

Based in an unfortunate tradition that stretches back in time to Watson's behaviorism and Freud's psychoanalysis, psychology has tended to reject and to pathologize matters of the spirit. In the past 30 years, however, with the advent of what has been termed the cognitive revolution, psychology has greatly expanded the scope of its subject matter. Psychologists and thanatologists have begun to unravel the cognitive underpinnings of our assumptive world and the transformation of those underpinnings in times of crisis and stress. This article examines the cognitive basis of the spiritual experience and the use of cognitive assimilation, accommodation strategies during the process of mourning the death of a loved one, as well as during the process of living our own dying. Of special importance to mental health professionals and clergy, new research on dying, mourning, and spirituality suggests that the specific ways in which people rediscover meaning--such as belief in traditional religious doctrine, the afterlife, reincarnation, philanthropy, or a spiritual order to the universe--may be less important than the process itself. In other words, in the midst of dealing with profound loss in our lives, the ability to reascribe meaning to a changed world through spiritual transformation, religious conversion, or existential change may be more significant than the specific content by which that need is filled.

Group therapy for emotionally disturbed children: a key to affective education.

This paper outlines the practical aspects of the operation of a therapeutic program for children with severe emotional problems in public schools. It discusses the merits of the group therapy approach in relation to other modalities, and sets out ground rules for the operation of groups by teachers.