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Between January and May 2012, a total of 286 bulk tank milk samples from dairy sheep farms located in central Italy were tested for the presence of Staphylococcus aureus. One hundred fifty-three samples were positive for S. aureus (53.5%), with an average count of 2.53 log cfu/mL. A total of 679 S. aureus colonies were screened for methicillin resistance by the cefoxitin disk diffusion test, and 104 selected cefoxitin-susceptible isolates were also tested for their susceptibility to other antimicrobials representative of the most relevant classes active against Staphylococcus spp. by using the Kirby-Bauer disk diffusion method. Two methicillin-resistant Staphylococcus aureus (MRSA) isolates, carrying respectively the mecA and the mecC genes, were detected in 2 samples from 2 different farms (prevalence 0.7%). The mecA-positive MRSA isolate was blaZ positive, belonged to spa type t127, sequence type (ST)1, clonal complex (CC)1, carried a staphylococcal cassette chromosome mec (SCCmec) type IVa, and was phenotypically resistant to all the β-lactams tested and to erythromycin, streptomycin, kanamycin, and tetracycline. The mecC-positive MRSA isolate was negative for the chromosomally or plasmid-associated blaZ gene but positive for the blaZ allotype associated with SCCmec XI (blaZ-SCCmecXI), belonged to spa type 843, ST(CC)130, carried a SCCmec type XI, and was resistant only to β-lactams. Both MRSA were negative for the presence of specific immune-evasion and virulence genes such as those coding for the Panton-Valentine leucocidin, the toxic shock syndrome toxin 1, and the immune evasion cluster genes. Regarding the presence of the major S. aureus enterotoxin genes, the mecC-positive MRSA tested negative, whereas the ST (CC)1 mecA-positive MRSA harbored the seh gene. Among the 104 methicillin-susceptible S. aureus isolates examined for antimicrobial susceptibility, 63 (60.58%) were susceptible to all the antimicrobials tested, and 41 (39.42%) were resistant to at least 1 antimicrobial. In particular, 23 isolates (22.12%) were resistant to tetracycline, 16 (15.38%) to sulfonomides, 14 (13.46%) to trimethoprim and sulfamethoxazole, and 9 (8.65%) to ampicillin, whereas only 1 isolate was resistant to both fluoroquinolones and aminoglycosides. The high prevalence of S. aureus found in bulk tank milk samples and the isolation of MRSA, although at a low prevalence, underlines the importance of adopting control measures against S. aureus in dairy sheep farms to minimize the risks for animal and public health. Moreover, this study represents the first report of mecC-positive MRSA isolation in Italy and would confirm that, among livestock animals, sheep might act as a mecC-MRSA reservoir. Although this lineage seems to be rare in dairy sheep (0.35% of farms tested), because mecC-positive MRSA are difficult to detect by diagnostic routine methods employed for mecA-positive livestock-associated MRSA, diagnostic laboratories should be aware of the importance of searching for the mecC gene in all the mecA-negative S. aureus isolates displaying resistance to oxacillin, cefoxitin, or both.

A total of 227 Staphylococcus aureus colonies, isolated from 54 samples of raw milk and dairy products of bovine, ovine, caprine and bubaline origin were tested for the presence of genes coding for staphylococcal enterotoxins (SEs/SEls) and for methicillin resistance. Ninety-three colonies, from 31 of the 54 samples (57.4%) and from 18 (69.2%) of the 26 farms of origin tested positive for SEs/SEls genes. Most isolates harboured more than one toxin gene and 15 different toxinotypes were recorded. The most frequent were “sec” gene alone (28.6%), “sea, sed, ser, selj” (20%), “seg, sei” and “seh” (8.6%). The 77 colonies harbouring “classical enterotoxins” genes (sea-sed) were further tested for enterotoxin production, which was assessed for 59.2% of the colonies. Three methicillin-resistant S. aureus (MRSA) isolates were detected in three different ovine milk/dairy product samples (1.3%). All isolates belonged to spa type t127, sequence type 1, clonal complex 1, SCCmec type IVa.

Postoperative pain is characterized by a wide variability of patients' pain perception and analgesic requirement. The study investigated the extent to which demographic and psychologic variables may influence postoperative pain intensity and tramadol consumption using patient-controlled analgesia (PCA) after cholecystectomy.Eighty patients, aged 18 to 70 years, with an American Society of Anesthesiologists physical status I or II and a body mass index between 18.5 and 24.9, undergoing laparoscopic cholecystectomy were enrolled. Self-rating anxiety scale (SAS) and self-rating questionnaire for depression (SRQ-D) were used--1 day before surgery--to assess patients' psychologic status. General anesthesia was standardized. PCA pump with intravenous tramadol was used for a 24-hour postoperative analgesia. Visual analog scale at rest (VASr) and after coughing (VASi) and tramadol consumption were registered. Pearson's and point biserial correlations, analysis of variance, and step-wise regression were used for statistical analysis.Pearson r showed positive correlations between anxiety, depression, and pain indicators (P0.05). Moreover, female patients had higher pain indicators (P0.05). Analysis of variance showed that anxious (P0.05) and depressed (P0.001) patients had higher pain indicators, which significantly decreased during the postoperative 24 hours (P0.00001). Regression analysis revealed that tramadol consumption was predicted by preoperative depression (P0.001). VASr was predicted by sex and SRQ-D (P0.05). VASi was predicted by sex and SAS (P0.05).Pain perception intensity was primarily predicted by sex with an additional role of depression and anxiety in determining VASr and VASi, respectively. Patients with high depression levels required a larger amount of tramadol.

This communication describes the isolation of Brucella suis (B. suis) biovar 2 in semi‑free‑range pigs located in the province of Rome, Italy. Sera of 28 pigs from a herd with reproductive problems were tested for brucellosis. Twenty-five sera (89%) were found positive to Rose Bengal Test (RBT), while 22 (79%) were positive to Complement Fixation Test (CFT). Two positive pigs were slaughtered, organs were collected and tested for the presence of bacteria. Brucella spp. was isolated from the spleens and the abdominal lymph nodes of the 2 subjects. The isolates were identified as B. suis biovar 2 by biochemical and Polymerase Chain Reaction (PCR) tests. The frequent infringement in the fences of the premises and the birth of striped piglets provided evidence that sows mated with wild boar, the major reservoir of B. suis biovar 2. Conversely, the isolation of B. suis biovar 2 from spleens and lymphnodes of seropositive slaughtered animals only, as well as the constant negative results from all vaginal swabs and the abortion materials tested, raise doubts on the implication of B. suis biovar 2 in the infertility of the holding.

Thymoma is the most frequent type of tumor in the anterior-superior mediastinum. The presentation of thymomas is variable; most are asymptomatic and others present themselves with local compression syndrome or parathymic syndrome; rarely thymomas appear as an acute emergency. Surgery is the treatment of choice for thymic tumors and complete resection is the most important prognostic factor. Surgery with adjuvant radiation is recommended for invasive thymoma. The anaesthetic management of patients with mediastinal thymoma undergoing thymectomy is associated with several risks related to potential airway obstruction, hypoxia and cardiovascular collapse. Patients at high risk of perioperative complications can be identified by the presence of cardiopulmonary signs and symptoms. However, asymptomatic thymomas have been occurred with acute cardiorespiratory complications under general anaesthesia. A careful preoperative evaluation of signs, symptoms, chest X-ray, CT scan, MRI, cardiac echogram and venous angiogram should be helpful to investigate neoplasm presence and the area of invasion; moreover, an adequate airway and cardiovascular management, such as performing an awake intubation in the sitting position, allowing spontaneous and non-controlled ventilation, a rigid bronchoscope available and a standby cardiopulmonary bypass, is suggested to prevent the main life-threatening cardiorespiratory complications.