Epidemiology of sepsis in Internal Medicine Units of Apulia: results of SEMINA (SEpsis Management in INternal medicine Apulia) study.

Background: The prevalence and mortality of sepsis in Internal Medicine Units (IMUs) is poorly understood as most of the data derive from studies conducted in Intensive Care Units. Aim of SEpsis Management in INternal medicine Apulia (SEMINA) study was to determine the prevalence of sepsis and the characteristics and outcomes of patients with Sepsis-3 criteria admitted in Apulia's Internal Medicine Units for over six months. Methods: The SEpsis Management in INternal medicine of Apulia study was a prospective, multicentre, observational study. Adult admissions to the 13 Apulia Region's Internal Medicine Units between November 15, 2018 and May 15, 2019 were screened for sepsis according to the Sepsis-3 criteria. Medical data were collected in electronic case report form. Results: Out of 7,885 adult patients of the Internal Medicine Units, 359 (4.55%) fulfilled the inclusion criteria, and 65 of them (18.1%) met the septic shock criteria. The patients enrolled were elderly, suffering from chronic poly-pathologies and from cognitive and functional impairment. The respiratory system was the most common site of infection and the most common pathogens isolated from blood cultures were Staphylococcus spp., E. coli, Klebsiella spp., Enterococcus spp. and Acinetobacter spp. The in-hospital fatality rate was 31.2% and was significantly higher for septic shock. Sequential Organ Failure Assessment score, dementia and infections from Acinetobacter spp. were independent risk factors for mortality. Conclusions: A high prevalence of sepsis and a high fatality rate were detected in Apulia Region's Internal Medicine Units. The high fatality rate observed in our study could be related to the underlying diseases and to the vulnerability of elderly patients admitted to our Internal Medicine Units.

Data on unveiling the occurrence of transient, multi-contaminated mafic magmas inside a rhyolitic reservoir feeding an explosive eruption (Nisyros, Greece).

This data article includes the description and the geochemical and mineralogical dataset of 67 pyroclastic rock samples from the Upper Pumice (UP) explosive activity of Nisyros volcano (eastern South Aegean Active Volcanic Arc). A detailed field and petrographic description of the studied outcrops and samples are reported, including representative photomicrographs and SEM images, whole-rock major and trace elements compositions of 31 representative samples and Sr-Nd isotope ratios on 22 selected samples. Analytical methods and conditions used for data acquisition are also reported. The UP eruption produced a stratigraphic sequence constituted by a basal fallout deposit, gradually substituted by pyroclastic density current (PDC) deposits; these are overlaid by a lag-breccia unit, and the sequence is closed by a grey ash flow level. The juvenile is mainly constituted by white-yellow, moderately crystalline pumice with rhyolitic composition and homogenous Sr-Nd isotope values. Variable amounts of dense, grey, crystalline juvenile lapilli clasts (CRC, Crystal-Rich Clast), with rounded shape and less evolved composition (andesite to dacite) are also present in the deposit. These mafic CRCs are peculiar due to their large variability in textures (from distinctive diktytaxitic to strongly fragmented structure without a defined fabric) and in the geochemical and isotopic composition. The data acquired were fundamental to reconstruct the complex and peculiar history of ascent, storage and differentiation/assimilation processes of these mafic melts before their intrusion into the shallow, rhyolitic magma chamber, with important implication on the possible eruption trigger during the more recent explosive phase of activity at Nisyros volcano. Moreover, the geochemical and isotopic analyses provide new original data to the general knowledge of the Aegean volcanics. All the data reported in this paper are related to the research article Braschi et al. (2022).

Concordance between superficial swab and deep sampling in post-sternotomy mediastinitis: Single center experience.

OBJECTIVES: Deep sampling (DS) is the gold standard for microbiological diagnosis of post-sternotomy mediastinitis (PSM), however superficial swab (SS) are frequently performed in some centers and antibiotherapy initiated base on their results. We analysed the concordance between superficial swab and deep sampling in PSM. MATERIALS AND METHODS: We analysed retrospectively patients with a PSM between 2010 and 2014 at Saint-Luc University hospital (Belgium). We considered that there was a concordance between SS and DS when the same microorganism was found in the two sampling method in each patient. Patients were stratified in six groups according to microbiology results as Staphylococcus Aureus (SA) sensitive or resistant, coagulase negative Staphylococcus (CoNS), Gram negative bacilli (GNB), other Gram positive bacteria (GPB) and fungi. RESULTS: Thirty-six patients were included. Twenty-five men (69%) and a mean age of 66 years old. The overall concordance between SS and DS was 57%. SA and GNB showed high concordance (100% and 85.7% respectively). For the other groups the concordance was low. The sensitivity and specificity of SS was 97% and 33% respectively. The PPV and NPV of superficial swab was 96% and 50% respectively. CONCLUSION: Microbiological results from SS, even with flocked swabs, except for SA and GNB have low concordance with those obtained from deep sampling. Our data confirm that in PSM, deep sampling is the gold standard for microbiological assessment.

Apolipoprotein E in Southern Italy: protective effect of epsilon 2 allele in early- and late-onset sporadic Alzheimer's disease.

Apolipoprotein E (apoE) polymorphism was evaluated in 81 sporadic late onset Alzheimer's disease (LOAD) patients, 28 sporadic early-onset Alzheimer's disease (EOAD) and 92 sex- and age-matched healthy controls from Apulia, Southern Italy. ApoE genotypes were determined by the polymerase chain reaction-restriction fragment length polymorphism method. The frequency of apoE epsilon 4 allele was significantly higher in EOAD patients than in the control group, but not in LOAD patients. Furthermore, EOAD patients carrying epsilon 4 allele had lower age at onset of AD symptoms (about 4. 5 years). In the whole sample, epsilon 4 was associated to AD by an odds ratio of 2.14, while it increased up to 6.55 in < 65 years old subjects. Finally, in both < 65 and > or = 65 subgroups of subjects, epsilon 2 played a protective role against the development of AD. It is concluded that the geographic decreasing trend of epsilon 4 allele and the age at onset may influence the association of apoE polymorphism with sporadic AD in a Southern Italian sample.

[Age-related cognitive decline: evaluation and prevention strategy]. / Declino cognitivo età-correlato: valutazione e strategie per la prevenzione.

The age-related decline of cognitive functions generally refers to a mild deterioration in memory performance, executive functions, and speed of cognitive processing. The terms "age-related cognitive decline" (ARCD) and "aging-associated cognitive decline" have been proposed recently to indicate an objective decline in cognitive functioning associated to the ageing process but within normal limits given the person's age. Whether ARCD is expression of a normal ageing process or represents a distinct clinical entity or, eventually, is a continuum with dementia is, at present, difficult to establish. The causes of ARCD are unknown, but some studies have suggested that it may be prevented. Avoidance of cardiovascular and other chronic diseases, high educational level, and maintenance of vision and hearing have been identified as protective factors from ARCD. On the contrary, hypertension, effects of altered metabolism of steroid hormones, smoking, low-complexity occupation, higher density of persons/bedroom in home, and low level of physical activity have been identified as risk factors for ARCD. Recent findings suggest a possible role of diet in the ARCD. In fact, in an elderly population of Southern Italy with a typical Mediterranean diet, high monounsaturated fatty acids energy intake appeared to be associated with a high protection against cognitive decline. Dietary antioxidants, specific macronutrients, estrogens, and anti-inflammatory drugs, may act synergistically with other protective factors, opening new therapeutic interventions for cognitive decline.

Increased bile acid excretion and reduction of serum cholesterol after crenotherapy with salt-rich mineral water.

The effect of a spring mineral water from Montecatini (Italy) on bile acid excretion, and lipid and apolipoprotein serum levels was evaluated. The study was conducted in subjects with serum total cholesterol (TC) level > 240 mg/dL and LDL cholesterol (LDL-C) > 170 mg/dL, over a 9-week period, with 3 weeks of dietary stabilization, 3 weeks of active treatment, and 3 weeks of tap-water treatment as a control period. Serum lipids and apolipoproteins, total and fractionated bile acid excretion, gallbladder motility, and safety parameters were evaluated. Active treatment with mineral water significantly reduced serum TC by 7.5%, LDL-C by 12.5%, TC/HDL-cholesterol ratio by 6.3%, and apolipoprotein B by 6.3%; total fecal bile acid excretion was increased by 98.9%, and gallbladder volume was reduced by 40%. The reduction in serum and LDL-cholesterol levels observed during the active treatment period ran parallel to the increased excretion of bile acids in the stools. We suggest that salt-rich spring water treatment reduces serum and LDL-cholesterol levels in subjects with mild hypercholesterolemia through a mechanism of increased excretion of fecal bile acid sterols.

High monounsaturated fatty acids intake protects against age-related cognitive decline.

OBJECTIVE: To study the relationships between dietary macronutrient intakes and age-related changes in cognitive functions. METHODS: We investigated these associations in the prevalence survey (1992 through 1993) of the Italian Longitudinal Study on Aging (ILSA). The population-based sample of 5,632 subjects of the ILSA, age 65 to 84 years, was identified from the electoral rolls of eight Italian municipalities. In this study, standardized test batteries assessing global cognitive functions (Mini-Mental State Examination [MMSE]), selective attention (Digit Cancellation Test [DCT]), and episodic memory (Babcock Story Recall Test), and a semi-quantitative food frequency questionnaire evaluating macronutrient energy intakes, were performed on 278 nondemented elderly subjects from the randomized cohort of Casamassima, Bari (n = 704). RESULTS: There was an inverse relationship between monounsaturated fatty acids (MUFAs) energy intake and cognitive decline (MMSE < 24). The effect of education on the odds of having a MMSE score <24 decreased exponentially with the increase of MUFA intakes (over 2,400 kJ; odds ratio, 0.69). Moreover, a significant inverse association was observed between MUFA intakes and DCT score (odds ratio, 0.99). No association was found between nutritional variables and episodic memory. CONCLUSIONS: In an elderly population of Southern Italy with a typical Mediterranean diet, high MUFA intakes appeared to be protective against age-related cognitive decline. Prospective clinical trials are needed to evaluate the impact of specific dietary macronutrient intakes on the age-related changes of cognitive functions.

Decreased frequency of apolipoprotein E epsilon4 allele from Northern to Southern Europe in Alzheimer's disease patients and centenarians.

Apolipoprotein E (apoE) polymorphism was studied in 79 sporadic late onset Alzheimer's disease (LOAD) patients, 125 unrelated caregivers or volunteers (19-80 years), and 67 centenarians from Apulia, Southern Italy. The frequency of apoE epsilon2 allele was higher in centenarians than in LOAD patients, while epsilon4 was lower. In middle-aged adults, the epsilon4 allele frequency was higher than in centenarians. The epsilon4 allele frequency was lower in healthy adults than in LOAD patients, while epsilon2 was higher. Compared with the allele frequencies of Northern and Central European countries, a geographic trend for epsilon3 and epsilon4 alleles in LOAD and middle-aged adults was observed. The frequency of epsilon3 increased from Northern to Southern Europe, while epsilon4 decreased significantly. In centenarians, epsilon2 showed a North-South increasing pattern, while epsilon4 was in opposite trend.

Analysis of some aspects of learning and memorization processes in an adult population.

This study evaluated the impact of aging, gender and education on learning function and memory process. Hundred-six normal subjects, in the age range 20-79 years were recruited, and their following functions were evaluated as inclusion criteria: (i) global cognitive performance by using the Mini Mental State Examination (MMSE > or = 24), (ii) depressive disorders by using the Hamilton Depression Rating Scale (HDRS < 14); (iii) intelligence and "problem solving" ability by means of the Raven's Colored Progressive Matrices (PM 47 > or = 9). The prospective memory and the working memory, the incidental memory, as well as the immediate and delayed visuo-verbal association of these subjects were evaluated in the daily life conditions with the aid of a personal computer. Statistical analysis was performed by a model of multiple linear regression. The results suggested that prospective memory and working memory was influenced by age and education in both sexes. The percental loss of visuo-verbal association was not influenced by education, but was by gender and age. Test exploring incidental memory evidenced a worsening of performance in both sexes, being influenced only by the age.

A rehabilitation program for mild memory impairments.

Eight subjects, 60-75 years of age, with at least 5 years of education and mild memory impairments were recruited for a rehabilitation program. Other 8 subjects, not exposed to the rehabilitative training and with the same neuropsychological profile, represented a control group. In the first day of this program an evaluation of cognitive/behavioral functions was performed. Our program consisted of a neuropsychological rehabilitative intervention along 12 weeks, with a 5-day-period of domiciliary training with a set of home exercises and a 1-day training in our Center with rehabilitative exercises administered with the aid of a personal computer, each week. Rehabilitative training administered in our Center was aimed at stimulating visuo-verbal, verbal and spatial memory and the utilization of "memory strategies". After 4, 8 and 12 weeks of therapeutic program, other evaluations of the cognitive functions with the same battery tests were performed to evaluate possible improvements: the results indicated an improvement of memory test scores that demonstrated the positive effect of neuropsychological training on memory performances. There was no improvement in the control group.

Correlation between neuropsychometric tests and semiquantitative evaluation of the regional cerebral blood flow (rCBF) in a group of outpatients affected by cognitive impairment.

In order to evaluate the correlation between the cognitive-behavioral performances and the regional blood-perfusion deficits of the brain, 18 elderly subjects affected by dementia of probably primary degenerative character have been studied. The patients were first examined by psychometric tests and then submitted to brain Single Photon Emission Computed Tomography (SPECT) using [(99m)Technetium]-d,l-hexamethyl-propylene-amine-oxine (Tc-HMPAO) for regional blood flow evaluation (rCBF). The cognitive-behavioral functions have been estimated by Mini Mental State Examination (MMSE), Randt Memory Test, Rey's 15 Words, Corsi's Block Tapping Test, Word Fluency Test, Sentence Construction, Sketch Copy, Toulouse-Pieron's test. Digit Symbol Test from Wechsler Adult Intelligence Scale, and the Progressive Matrices 1947 (PM 47). The cerebral blood flow reduction in left occipital lobe and left frontal lobe explained 67% of the visuo-verbal memory impairment of the patients. These results suggest that the decrease of cognitive functions is related to some extent to a lower cerebral blood perfusion.

Impact of aging on the relationships between impairment of "Orientation" and "Recall" items of MMSE and mild to moderate mood disorders.

The association of depression and dementia is far more common than the masking of depression by dementia, i.e., pseudodementia. The impact of aging was investigated on the relationships between mood disorders, evaluated by means of Hamilton Depression Rating Scale (HDRS) and early cognitive impairments, measured by using the Mini Mental State Examination (MMSE) in 100 aged subjects (age range 60-84 years). In our population of mildly to moderately depressed elderly people, the aging was associated with a loss of MMSE item "Orientation" and a loss of MMSE item "Recall"; this could be explained by an association of cognitive impairment and mild to moderate depressive disorders which are worsening with aging.