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Abstract Background During the outbreak of SARS-CoV-2 in Italy, infection among health-care professionals and in the context of welfare and health-care facilities was a significant concern. It is known that the elderly or those with concomitant pathologies are at greater risk of a serious evolution of the disease if affected by COVID-19 and that health workers are a category with greater exposure to SARS-CoV-2 infection. Until now, there has been little information on the epidemiological features and transmission dynamics of the COVID-19 outbreak which did not involve health-care professionals or social and health-care facilities. For this reason, this paper aims to describe the epidemiological characteristics of SARS-CoV-2 infection in the general population outside these semi-closed communities. Methods The study was designed by analyzing the data of the 1371 SARS-CoV-2 positive subjects observed in Sardinia up to 9 July, 2020 and whose data were available in the public health department. Statistical analysis and graphic representation were performed using STATA and Adobe Illustrator, respectively. Results Of the positive cases analyzed, 323 (23.5%) are health-care workers and 563 (41.1%) reside in social or health-care facilities. The number of positive cases among the general population (subjects who do not belong to these semi-closed communities), is 399 (29.1%), 208 females and 191 males. The estimated Case Fatality Rate stands at 5.0%, which is almost half the rate reported for all the SARS-CoV-2 positive cases (9.8%). The geographical distribution of positive cases differs considerably from the distribution of the totality of cases in Sardinia. Conclusions This review provides an insight into the COVID-19 situation in the general community, ie not involving health-care professionals or social and health-care facilities. Understanding the evolving epidemiology and transmission dynamics of the outbreak outside of these semi-closed communities would provide appropriate information to guide intervention policy. The COVID-19 pandemic has exacerbated the vulnerability of our health-care system. Severe disruptions in care, medicine shortages and unequal access to health-care are but a few examples of the challenges faced by people living in Italy and Europe, highlighting the importance of evidence-based approaches in supporting the development of prevention and response strategies for future pandemics.

In order to survive the exposure to acid pH, Escherichia coli activates molecular circuits leading from acid tolerance to extreme acid resistance (AR). The activation of the different circuits involves several global and specific regulators affecting the expression of membrane, periplasmic and cytosolic proteins acting at different levels to dampen the harmful consequences of the uncontrolled entry of protons intracellularly. Many genes coding for the structural components of the AR circuits (protecting from pH ≤ 2.5) and their specific transcriptional regulators cluster in a genomic region named AFI (acid fitness island) and respond in the same way to global regulators (such as RpoS and H-NS) as well as to anaerobiosis, alkaline, cold and respiratory stresses, in addition to the acid stress. Notably some genes coding for structural components of AR, though similarly regulated, are non-AFI localised. Amongst these the gadBC operon, coding for the major structural components of the glutamate-based AR system, and the ybaS gene, coding for a glutaminase required for the glutamine-based AR system. The yhiM gene, a non-AFI gene, appears to belong to this group. We mapped the transcription start of the 1.1 kb monocistronic yhiM transcript: it is an adenine residue located 22 nt upstream a GTG start codon. By real-time PCR we show that GadE and GadX equally affect the expression of yhiM under oxidative growth conditions. While YhiM is partially involved in the RpoS-dependent AR, we failed to detect a significant involvement in the glutamate- or glutamine-dependent AR at pH ≤ 2.5. However, when grown in EG at pH 5.0, the yhiM mutant displays impaired GABA export, whereas when YhiM is overexpressed, an increases of GABA export in EG medium in the pH range 2.5–5.5 is observed. Our data suggest that YhiM is a GABA transporter with a physiological role more relevant at mildly acidic pH, but not a key component of AR at pH < 2.5.

Purpose: The purpose of this study was to assess the rate with which radiologists reported spinal epidural lipomatosis (SEL) when interpreting lumbosacral magnetic resonance imaging (MRI) examination., Materials and Methods: A total of 450 lumbosacral MRI examinations obtained in 450 patients were included (199 men, 251 women; mean age, 56.7 ± 13.5 [SD] years; age range: 18-91 years).  Three senior radiologists assessed and classified independently SEL on MRI according to the Borré grading system (Grade 1 to Grade 3). Depiction of SEL on MRI reports (i. e., reporting rate) and association with patients' symptoms were verified., Results: SEL was found in 75/450 patients (prevalence = 16.7%), and classified as grade-1 (mild) in 49/75 (65.3%) patients, grade-2 (moderate) in 24/75 (32%), and grade-3 (severe) in 2/75 (2.7%). SEL was diagnosed on MRI report in 6/75 (8%) patients. SEL prevalence based on MRI reports was 1.3% (6/450), significantly lower than its actual prevalence based on MRI examinations (P < 0.0001). The reporting rate was 0% in grade-1 (0/19), 10.2% in grade-2 (5/49) and 50.0% in grade-3 (1/2), and variable on the radiologist subspecialty (10.0% among musculoskeletal radiologists, 11.1% among neuroradiologists, and 3.7% among generalists). SEL was considered as the only cause of symptoms in 7/75 patients (9.3%) and a concurrent cause in 9/75 (12%)., Conclusion: SEL reporting rate is extremely low, leading to an important underestimation of disease prevalence. SEL diagnosis and grading should be refined to improve reports quality and subsequently patient care., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial or personal relationships that could be viewed as influencing the work reported in this paper., (Copyright © 2022. Published by Elsevier Masson SAS.)