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Here, we evaluated the frequency of C. difficile colonization and its impact on clinical outcomes in patients admitted to intensive care units in Brazil. From ninety-two patients screened 16 (17.3%) were colonized by C. difficile. Colonized patients had higher Simplified Acute Physiology Score III (SAPS III), however there was no association between C. difficile colonization with diarrhea or mortality. The C. difficile strains sequenced belonged to clade 1 and presented high vancomycin-resistant rates.

L’appropriatezza nella richiesta di esami clinici di laboratorio e una modalita operativa per rendere il percorso diagnostico efficace e di conseguenza efficiente, evitando lo spreco di risorse. La selezione dell’esame strumentale atto a completare il percorso diagnostico deriva da principi o regole di appropriatezza ma e imposto sempre piu con forza anche da necessita di budget. Il lavoro descrive la condivisione da parte di prescrittori e esecutori di linee guida da utilizzare, in ambito locale, nella pratica della gestione del paziente con scompenso cardiaco. Abbiamo esaminato la numerosita di richieste di esami per valutare l’adesione alle indicazioni proposte e per comprendere, anche alla luce della letteratura scientifica, le potenziali applicazioni della determinazione dei peptidi natriuretici e la globale efficacia diagnostica di questo esame. Il percorso di appropriatezza della richiesta di esami ematochimici ha condotto a diminuzione di analiti “sentinella”, verso i quali erano state indirizzate raccomandazioni prescrittive condivise con i medici in ambito locale. L’analisi sistematica degli esami prescritti e degli importi dettagliati di spesa ha messo in evidenza la crescente richiesta di peptidi natriuretici e la necessita quindi di intervenire condividendo principi di richiedibilita. Ne e derivato un documento sintetico atto a veicolare messaggi relativi all’appropriatezza del ricorso alla determinazione di peptidi natriuretici e promuovere un approccio clinico al paziente con segni e sintomi di scompenso cardiaco. E inoltre emerso un utilizzo meno pragmatico del peptide natriuretico che, in ambito nefrologico, apre a nuovi e interessanti scenari applicativi. E’ importante seguire attentamente l’andamento delle richieste di esami, soprattutto se costosi, e indirizzare al rispetto dell’ambito indicato da linee guida internazionali. Non sempre e possibile contenere entro limiti ristretti la richiesta di esami che, all’atto pratico, forniscono informazioni che possono tradursi in facilitazioni nella gestione complessiva del paziente. In tal caso la valutazione dell’impatto economico deve essere eseguita su un piu ampio ambito, che tenga conto del complesso di attivita necessarie a diagnosi e terapia.

Morphologic, instrumental (flow cytometric), cytochemical, ultrastructural, and chromosomal studies were performed in 21 cases of eosinophilic peroxidase deficiency that were observed in an area of northeastern Italy in the last 5 years. It was found that eosinophilic peroxidase deficiency occurred with a frequency of 1 case in 14,000 complete blood counts yearly, and thus is less rare than previously thought. Eosinophils appeared morphologically normal when examined using the light microscope, but ultrastructural study disclosed several aspecific granule alterations. In the first family studied, members with partial and total deficit were identified; in all the other cases, the enzyme deficit was total (negative cytochemical reactions and absence of dimethylaminoazobenzene-positive specific granules at the electron microscope), isolated (a single affected member in each family examined), and stable (persistent at long-term follow-up). Eosinophilic peroxidase deficiency was not correlatable with any particular disease, although a nonsignificant association with allergic-type conditions was observed. Studies are in progress to examine the modality of the defect's genetic transmission, as well as problems related to possible functional alterations and correlated clinical consequences.

The present study measured triglycerides (TG), total cholesterol (TC), HDLcholesterol (HDL-C), LDL and LDL/HDL-C, TC/HDL-C and HDL-C/TC. 100 ratios in 261 men and women undergoing coronary arteriography. The results show that TG, TC, HDL-C and LDL levels are not related to the severity of coronary artery disease (CAD). The LDL/HDL-C, TC/HDL-C and HDL/TC.100 ratios are statistically related to the severity of CAD. The LDL/HDL-C ratio appeared to be the most sensitive index for reflecting CAD of mild severity with a predictive value of 83.3% at 76.6% specificity and at 77.7% sensitivity (cut-off: 3.20). Average values of LDL and HDL-C alone are not reliable indices of mild severity CAD.

Blood samples collected after venipuncture and skin-puncture from a series of ten healthy volunteers were used to determine platelet counts, mean platelet volumes (MPVs), and platelet distribution width (PDW). Measurements were performed on untreated venous whole blood and on whole or diluted samples, with or without anticoagulants. In this study, platelet indices were significantly different in untreated venous whole blood in comparison with blood from skin puncture and whole blood with anticoagulant.