Knowledge of, and attitudes towards, adult vaccination among General Practitioners in Piedmont, Italy: results from a cross-sectional study.

Background: "Life-course immunization" is increasingly recognized as important. In Italy, adults are recommended to receive influenza; pneumococcal; tetanus toxoid, reduced diphtheria toxoid, acellular pertussis (Tdap); and herpes zoster (HZ) vaccines at various ages. Study design: Cross-sectional study. Methods: To study the knowledge and attitudes of Italian general practitioners (GPs) towards adult vaccination, we surveyed 335 GPs in Piedmont from December 2019 through March 2020; and compared the results by GPs' age (≤50 vs >50 years). Results: The most common vaccination information source was the regional/local educational courses (72.8%), with older vs younger GPs more likely to attend (79.4% vs 64.4%; p=0.002). Approximately half felt that they needed further information on vaccine co-administration (55.5%), duration of protection (49.6%), and safety/tolerability (48.7%), with older vs younger GPs being more interested in safety/tolerability. Overall, most respondents (86.0%) felt that information for the patient would most engage them, and 68.1% planned to co-administer vaccines. Respondents felt most comfortable proposing influenza, but were also comfortable about pneumococcal/Tdap/HZ vaccination. However, younger vs older GPs were more comfortable about proposing Tdap and HZ. The most common ways to inform patients about influenza or pneumococcal/Tdap/HZ vaccination eligibility were personally during a visit (42.7% or 54.3%, respectively) or via an information poster (30.7% or 17.9%). Conclusions: The surveyed GPs had favorable attitudes towards adult vaccination and were interested in ongoing education.

Azole-resistant Aspergillus fumigatus in the environment of northern Italy, May 2011 to June 2012.

In recent years acquired azole resistance in Aspergillus fumigatus has been increasingly reported and a dominant mechanism of resistance (TR34/L98H) was found in clinical and environmental isolates. The aim of the present study was to investigate the prevalence of azole resistance in environmental A. fumigatus isolates collected in northern Italy. A. fumigatus grew from 29 of 47 soil samples analysed. Azole-resistant isolates were detected in 13% (6/47) of the soil samples and in 21% (6/29) of the soil samples containing A. fumigatus. High minimal inhibitory concentrations (MIC) of itraconazole (≥16 mg/L) and posaconazole (≥0.5 mg/L) were displayed by nine isolates from six different soil samples, namely apple orchard (1 sample), rose pot compost (2 samples), and cucurbit yields (3 samples). Seven isolates had a MIC=2 mg/L of voriconazole. Seven of nine itraconazole and posaconazole resistant isolates harboured the same TR34/L98H mutation of cyp51A. These findings, together with the occurrence of resistant clinical isolates, suggest that azole resistance should be considered in primary patient care.

Liver cell adenomas and portosystemic shunt.

We report the case of a young man who developed multiple liver cell adenomas 13 years after a mesentericocaval shunt. Radiological findings did not provide diagnosis. Histological findings of two biopsied nodules were compatible with liver cell adenoma. Our patient had no known risk factors for liver cell adenomas. We discuss the hypothesis that disturbed hepatic vascularisation could promote the development of liver cell adenomas.

The accuracy of the FIB-4 index for the diagnosis of mild fibrosis in chronic hepatitis B.

BACKGROUND: The Fib-4 index is a simple and inexpensive biomarker to delineate liver fibrosis in chronic hepatitis C. AIM: To assess the accuracy of the FIB-4 index in chronic hepatitis B. METHODS: We compared the FIB-4 index with 138 synchronous liver biopsies and with 372 synchronous FibroTest performed either in France or in an endemic area (Mayotte, an overseas collectivity of France). RESULTS: The FIB-4 index allowed the correct identification of patients with nil-to-moderate fibrosis with an area under the receiving operating characteristic curve of 0.81 (P < 0.001), increasing as a function of the length of the liver biopsy (up to 0.94 for liver biopsies >or=20 mm). A cut-off value