Search

BackgroundWe aim to evaluate whether fertility, pregnancy, delivery and breastfeeding have been actually improving in women with multiple sclerosis (MS), compared with general population, and in relation to treatment features.MethodsWe included 2018–2020 population-level healthcare data on women with MS living in the Campania region (Italy). Fertility, pregnancy and delivery outcomes were obtained from Certificate of Delivery Assistance; breastfeeding was collected up to 6 months after delivery by trained personnel.ResultsOut of 2748 women with MS in childbearing age, 151 women delivered 156 babies. Fertility rate was 0.58 live births per woman with MS, compared with 1.29 in Campania region and 1.25 in Italy. Disease-modifying treatment (DMT) continuation during pregnancy was associated with lower birth weight (coeff −107.09; 95% CI –207.91 to –6.26; p=0.03). Exposure to DMTs with unknown/negative effects on pregnancy was associated with birth defects (OR 8.88; 95% CI 1.35 to 58.41; p=0.02). Birth defects occurred in pregnancies exposed to dimethyl fumarate (2/21 exposed pregnancies), fingolimod (1/11 exposed pregnancies) and natalizumab (2/30 exposed pregnancies). After delivery, 18.8% of women with MS were escalated of DMT efficacy, while 50.7% started on same/similar-efficacy DMTs, and 30.5% did not receive DMT. The probability of breastfeeding was higher in women who were treated with breastfeeding-safe DMTs (OR 5.57; 95% CI 1.09 to 28.55; p=0.03).ConclusionsFertility rate in women with MS remains below the general population. Family planning and subsequent DMT decisions should aim to achieve successful pregnancy, delivery and breastfeeding outcomes, while controlling disease activity.

AimsTo date, reverse transcriptase PCR (RT-PCR) on nasopharyngeal swabs is the ‘gold standard’ approach for the diagnosis of COVID-19. The need to develop easy to use, rapid, robust and with minimal hands-on time approaches are warranted. In this setting, the Idylla SARS-CoV-2 Test may be a valuable option. The aim of our study is to evaluate the analytical and clinical performance of this assay on previously tested SARS-CoV-2 people by conventional RT-PCR based approach in different settings, including initial diagnosis and clinical follow-up.MethodsTo evaluate the sensitivity and specificity of the Idylla SARS-CoV-2 Test, we retrieved 55 nasopharyngeal swabs, previously analysed by a fully validated assay, from symptomatic patients or from people who have been in close contact with COVID-19 positive cases. Discordant or high discrepant cases were further analysed by a third technique. In addition, a second subset of 14 nasopharyngeal swab samples with uncertain results (cycle threshold between 37 and 40), by using the fully validated assay, from patients with viral infection beyond day 21, were retrieved.ResultsOverall, Idylla showed a sensitivity of 93.9% and a specificity of 100.0%. In addition, in the additional 14 nasopharyngeal swab samples, only five (35.7%) featured a positive result by the Idylla SARS-CoV-2 Test.ConclusionsWe demonstrated that the Idylla SARS-CoV-2 Test may represent a valid, fast, highly sensitive and specific RT-PCR test for the identification of SARS-CoV-2 infection.

In this paper, Lean and Six Sigma (LSS) methodologies have been used to define, measure, analyse, improve, and control the occurrence of healthcare-associated infections affecting patients' safety at the adult Intensive Care Unit of the University Hospital 'Federico II'. The first (01/01/2014-28/02/2015) and second data collection campaign (01/03/2015-28/02/2016) involved 144 and 154 patients, respectively. The results show that Acinetobacter baumannii is the dominant bacterium and a positive correlation exists between the number of colonized patients and the number of healthcare procedures the patients undergo. The different parameters influencing the process and the distribution of the sentinel bacterium have been also identified.

ABSTRACTSeasonal influenza is a very common disease. Yearly vaccination of at-risk population groups is a well-recognized cost-effective/cost-saving preventive measure. It is, however, unclear which available alternative has the most favorable economic profile. Some available options are: trivalent (TIV) and quadrivalent (QIV) inactivated vaccines, adjuvanted TIV (aTIV). Because of immunosenescence, aTIV has been specifically developed for elderly. The present study aimed at assessing the available evidence of aTIV use in elderly from the economic perspective. A systematic literature review targeting aTIV economic evaluations in adults aged ≥65 years was performed using Medline via Ovid, Embase, DARE and NHS/EED. Of a total of 3,654 papers screened, 18 studies (13 full papers, 5 conference abstracts) were included. It emerged that compared with both non-vaccination or non-adjuvanted vaccines, aTIV was cost-effective or cost-saving. The vaccinations strategies incorporating aTIV based on age and/or risk profile are associated with the most favorable economic outcomes.

ABSTRACTIntroduction: Prostaglandin D2(PGD2) is a major cyclooxygenase mediator that is synthesized by activated human mast cells and other immune cells. The biological effects of PGD2are mediated by D-prostanoid (DP1), DP2(CRTH2) and thromboxane prostanoid (TP) receptors that are expressed on several immune and non-immune cells involved in allergic inflammation. PGD2exerts various proinflammatory effects relevant to the pathophysiology of allergic disorders. Several selective, orally active, DP2receptor antagonists and a small number of DP1receptor antagonists are being developed for the treatment of allergic disorders.Areas covered: The role of DP2and DP1receptor antagonists in the treatment of asthma and allergic rhinitis.Expert opinion: Head-to-head studies that compare DP1antagonists with the standard treatment for allergic rhinitis are necessary to verify the role of these novel drugs as mono- or combination therapies. Further clinical trials are necessary to verify whether DP2antagonists as monotherapies or, more likely, as add-on therapies, will be effective for the treatment of different phenotypes of adult and childhood asthma. Long-term studies are necessary to evaluate the safety of targeted anti-PGD2treatments.

•Validation of an algorithm to estimate incidence of MS using routinely-collected healthcare data in the Campania Region (South Italy).•Estimation of spatial and temporal trends in MS relative risks using a Bayesian-based methodology.•Estimation of the proportion of undetected cases in MS.

COVID-19 pandemic represented a unique stressful event that affected the physical health and psychological well-being (PWB) of individuals and communities. Monitoring PWB is essential not only to clarify the burden on mental health effects but also to define targeted psychological-supporting measures. This cross-sectional study evaluated the PWB of Italian firefighters during the pandemic.

•The likelihood of DMT switch correlates significantly with Gd and spinal cord MRI.•The likelihood of switch from platform to high-efficacy DMT decreases over time.•The use of Gd acquisitions should be limited to early treatment phases.

Interferon-β has long-term safety and efficacy profiles for Relapsing Remitting Multiple Sclerosis (RRMS). However, the increasing number of available treatments requires to improve patient profiling and to perform individualized clinical decisions. Therefore, the present study investigated predictors of Interferon-β discontinuation.

In the past few years, researchers have focused on the development of three-dimensional (3D) advanced scaffolds and multifunctional hydrogel-based materials.

This paper describes an application of analytic hierarchy process (AHP) to enhance interactive budgeting in one of the biggest public university hospitals in Italy. AHP improved budget allocation facilitating elicitation and formalisation of units' needs. Furthermore, AHP facilitated vertical communication among managers and stakeholders, as it allowed multilevel hierarchical representation of hospital needs, and horizontal communication among staff of the same hospital, as it allowed units' need prioritisation and standardisation, with a scientific multi-criteria approach, without using complex mathematics. Finally, AHP allowed traceability of a complex decision-making process (as budget allocation), this aspect being of paramount importance in public sectors, where managers are called to respond to many different stakeholders about their choices.

Background The epidemiological decrease of Helicobacter pylori(Hp) infection has been recently associated to the increase of several extra-intestinal allergic disorders.Objective We investigated the role of specific Hp IgG production in the development of IgE or not IgE mediated food allergy (FA) in children affected by atopic dermatitis (AD).Methods From January 2010 to July 2013, 290 South Italian children, aged between 26 and 142 months, were consecutively referred to the Pediatric Clinic of the Pediatric Department at Second University of Naples and were diagnosed as affected by AD. The patients were classified in two groups on the basis of diagnosis of food allergy (88 FA affected and 202 not FA affected) and further divided on the basis of the diagnosis of atopy (63 IgE mediated and 23 not IgE mediated). Hp serum IgG was detected using an enzyme linked immunosorbent assay (ELISA) kit (Wampole® Helicobactor pylori IgG ELISA II, Wampole Laboratories, Cranbury, NJ) and Hp stool antigens using enzyme immunoassay (Premier Platinum HpSa plus, Cincinnati OH).Results We found a statistically significant higher prevalence of Hp serology positivity in not FA vs. FA AD-affected children (p= 0.032) and a significant inverse association between FA and Hp immunization (1/OR 0.32 95% CI 0.11–0.95). Further, we identified an absolute prevalence Hp serology positivity in not-IgE-mediated rather than in IgE-mediated FA AD-affected patients (p= 0.0006).Conclusion We hypothesize that specific Hp IgG production could protect against the development of both FA and atopy in AD-affected children.

The epidemiological decrease of Helicobacter pylori(Hp) infection has been recently associated to the increase of several extra-intestinal allergic disorders. We investigated the role of specific Hp IgG production in the development of IgE or not IgE mediated food allergy (FA) in children affected by atopic dermatitis (AD). From January 2010 to July 2013, 290 South Italian children, aged between 26 and 142 months, were consecutively referred to the Pediatric Clinic of the Pediatric Department at Second University of Naples and were diagnosed as affected by AD. The patients were classified in two groups on the basis of diagnosis of food allergy (88 FA affected and 202 not FA affected) and further divided on the basis of the diagnosis of atopy (63 IgE mediated and 23 not IgE mediated). Hp serum IgG was detected using an enzyme linked immunosorbent assay (ELISA) kit (Wampole® Helicobactor pylori IgG ELISA II, Wampole Laboratories, Cranbury, NJ) and Hp stool antigens using enzyme immunoassay (Premier Platinum HpSa plus, Cincinnati OH). We found a statistically significant higher prevalence of Hp serology positivity in not FA vs. FA AD-affected children (p?=?0.032) and a significant inverse association between FA and Hp immunization (1/OR 0.32 95% CI 0.11–0.95). Further, we identified an absolute prevalence Hp serology positivity in not-IgE-mediated rather than in IgE-mediated FA AD-affected patients (p?=?0.0006). We hypothesize that specific Hp IgG production could protect against the development of both FA and atopy in AD-affected children.

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011–2012 season. Vaccinated MRs were older (P= 0.006), working in clinical settings (P= 0.048), and vaccinated in the 2 previous seasons (P< 0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011–2012 season (P< 0.001). “To avoid spreading influenza among patients” was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs.Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future.

ABSTRACTThe molecular epidemiology of multidrug-resistant Acinetobacter baumanniiwas investigated in two intensive care units of the V. Monaldi university hospital in Naples, Italy, from May 2006 to December 2007. Genotype analysis by pulsed-field gel electrophoresis (PFGE), trilocus sequence-based typing (3LST), and multilocus sequence typing (MLST) of A. baumanniiisolates from 71 patients identified two distinct genotypes, one assigned to PFGE group A, 3LST group 1, and ST2 in 14 patients and the other to PFGE group B, 3LST group 6, and ST78 in 71 patients, that we named ST2/A and ST78/B, respectively. Of these, ST2/A corresponded to European clone II identified in the same hospital during 2003 and 2004; ST78/B was a novel genotype that was isolated for the first time in May 2006 but became prevalent during 2007. The ST78/B profile was also identified in five patients from two additional hospitals in Naples during 2007. The ST2/A and ST78/B isolates were resistant to all antimicrobials tested, including carbapenems, but were susceptible to colistin. Both ST2/A and ST78/B isolates possessed a plasmid-borne carbapenem-hydrolyzing oxacillinase gene, blaOXA-58, flanked by ISAba2and ISAba3elements at the 5' and 3' ends, respectively. The selection of the novel ST78/B A. baumanniiclone might have been favored by the acquisition of the blaOXA-58gene.

ABSTRACTWe investigated the basis of the carbapenem resistance of 17 multidrug-resistant Acinetobacter baumanniiclinical isolates collected from 2004 to 2005 at the Saint George University Hospital in Beirut, Lebanon. A. baumanniiisolates were clonally related and were susceptible to colistin and trimethoprim-sulfamethoxazole, susceptible or intermediate to ampicillin-sulbactam and meropenem, and resistant to all other antimicrobials. Conjugation experiments demonstrated that resistance to imipenem could be transferred along with a plasmid containing the carbapenem-hydrolyzing oxacillinase blaOXA-58gene. The plasmid that we called pABIR was 29,823 bp in size and showed a novel mosaic structure composed of two origins of replication, four insertion sequence (IS) elements, and 28 open reading frames. The blaOXA-58gene was flanked by IS18and ISAba3elements at the 5′ and 3′ ends, respectively. The production of the carbapenem-hydrolyzing oxacillinase OXA-58 was apparently the only mechanism for carbapenem resistance in A. baumanniiisolates causing the outbreak at the Lebanese Hospital.

We investigated the basis of the carbapenem resistance of 17 multidrug-resistant Acinetobacter baumannii clinical isolates collected from 2004 to 2005 at the Saint George University Hospital in Beirut, Lebanon. A. baumannii isolates were clonally related and were susceptible to colistin and trimethoprim-sulfamethoxazole, susceptible or intermediate to ampicillin-sulbactam and meropenem, and resistant to all other antimicrobials. Conjugation experiments demonstrated that resistance to imipenem could be transferred along with a plasmid containing the carbapenem-hydrolyzing oxacillinase blaOXA-58gene. The plasmid that we called pABIR was 29,823 bp in size and showed a novel mosaic structure composed of two origins of replication, four insertion sequence (IS) elements, and 28 open reading frames. The blaOXA-58gene was flanked by IS18 and ISAba3 elements at the 5' and 3' ends, respectively. The production of the carbapenem-hydrolyzing oxacillinase OXA-58 was apparently the only mechanism for carbapenem resistance in A. baumannii isolates causing the outbreak at the Lebanese Hospital.

ABSTRACTThe molecular epidemiology of multidrug-resistant Acinetobacter baumanniiwas investigated in the medical-surgical intensive care unit (ICU) of a university hospital in Italy during two window periods in which two sequential A. baumanniiepidemics occurred. Genotype analysis by pulsed-field gel electrophoresis (PFGE) of A. baumanniiisolates from 131 patients identified nine distinct PFGE patterns. Of these, PFGE clones B and I predominated and occurred sequentially during the two epidemics. A. baumanniiepidemic clones showed a multidrug-resistant antibiotype, being clone B resistant to all antimicrobials tested except the carbapenems and clone I resistant to all antimicrobials except ampicillin-sulbactam and gentamicin. Type 1 integrons of 2.5 and 2.2 kb were amplified from the chromosomal DNA of epidemic PFGE clones B and I, respectively, but not from the chromosomal DNA of the nonepidemic clones. Nucleotide analysis of clone B integron identified four gene cassettes: aacC1, which confers resistance to gentamicin; two open reading frames (ORFs) coding for unknown products; and aadA1a, which confers resistance to spectinomycin and streptomycin. The integron of clone I contained three gene cassettes: aacA4, which confers resistance to amikacin, netilmicin, and tobramycin; an unknown ORF; and blaOXA-20, which codes for a class D ß-lactamase that confers resistance to amoxicillin, ticarcillin, oxacillin, and cloxacillin. Also, the blaIMPallele was amplified from chromosomal DNA of A. baumanniistrains of PFGE type I. Class 1 integrons carrying antimicrobial resistance genes and blaIMPallele in A. baumanniiepidemic strains correlated with the high use rates of broad-spectrum cephalosporins, carbapenems, and aminoglycosides in the ICU during the study period.

To evaluate associations between exposure to disinfection byproducts in drinking water and adverse birth outcomes, personal exposure to disinfection byproducts must take into consideration multiple routes of exposure.

•COVID-19 will be circulating until vaccination and/or herd immunity is achieved.•Disease modifying treatments cannot be postponed indefinitely.•Logistics and COVID-19 testing can allow “new normal” healthcare delivery, while maintaining patients safe.

<it>Objectives</it>: We evaluated the genetic and molecular basis of high-level resistance to gentamicin and amikacin in 91 clinical isolates of <it>Enterococcus faecalis</it> and <it>Enterococcus faecium</it> in a university hospital in southern Italy from 1987 to 2003. <it>Methods</it>: Antibiotic susceptibility was evaluated by disc diffusion and microdilution methods. Genotyping was performed by PFGE and dendrogram analysis. Aminoglycoside resistance genes were analysed by multiplex PCR. Aminoglycoside resistance gene transfer was performed by filter mating. <it>Results</it>: In our strain collection, 44% of <it>E. faecalis</it> and 52% of <it>E. faecium</it> were high-level-resistant to gentamicin. Fifty-two PFGE profiles were identified for <it>E. faecalis</it> and 15 for <it>E. faecium</it>. Although the majority of PFGE patterns were single isolates, four patterns (two for <it>E. faecalis</it> and two for <it>E. faecium</it>) were isolated each in 8 and 4, and 6 and 4 different patients, respectively. The <it>aac(6′)-Ie-aph(2″)-Ia</it> gene was responsible for high-level resistance to gentamicin and amikacin in <it>E. faecalis</it> and <it>E. faecium</it>; the <it>aph(2″)-Id</it> gene responsible for resistance to gentamicin was also isolated in <it>E. faecium</it>; the <it>aph(3′)-IIIa</it> and <it>ant(4′)-Ia</it> genes responsible for resistance to amikacin were also isolated in <it>E. faecalis</it> and <it>E. faecium</it>. High-level resistance to gentamicin, along with the <it>aac(6′)-Ie-aph(2″)-Ia</it> gene, was transferred at a frequency of about 10−5 to 10−8 per recipient cell in 14 of 17 <it>E. faecalis</it> and 3 of 4 <it>E. faecium</it> different genotypes. <it>Conclusions</it>: The spread of the <it>aac(6′)-Ie-aph(2″)-Ia</it> gene was responsible for high-level resistance to gentamicin and amikacin among enterococci isolated from patients in our geographical area.