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Many African countries, representing the origin of the majority of refugees, asylum-seekers, and other migrants, toward regions bordering on the Mediterranean area, are experiencing sustained local transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Sicily is one of the main entry gates of migrants crossing into Europe. We conducted a pilot study, based on the full-genome sequencing of SARS-CoV-2 strains isolated from migrants coming to Sicily by crossing the Mediterranean Sea, with the aim to investigate the viral genome polymorphism and to describe their genetic variations and the phylogenetic relationships. On June 21, a nongovernmental organization vessel rescued 210 migrants crossing the Mediterranean Sea from Libya to Sicily. Of them, 13.4% tested positive for SARS-CoV-2. Eighteen whole genome sequences were obtained to explore viral genetic variability. All but one of the sequences clustered with other viral African strains within the lineage A, whereas only one intermixed among B.1 lineage genomes. Our findings documented that most of the investigated migrants acquired SARS-CoV-2 infection before landing in Sicily. However, SARS-CoV-2 transmission during travel or in overcrowded Libyan immigrant camps and/or illegal transport boats could not be ruled out. SARS-CoV-2 molecular surveillance on migrants arriving in Europe through the Sicilian gate may improve the knowledge of global SARS-CoV-2 transmission dynamic also in light of the emergence of new variants.

INTRODUZIONE Circa il 20% degli Operatori Sanitari (OS) contrae annualmente una patologia da virus influenzale e la vaccinazione stagionale è fortemente raccomandata quale migliore strategia di prevenzione tra gli OS. Diverse iniziative sono state messe in atto a livello nazionale per incrementare le scarse coperture vaccinali antinfluenzali evidenziate tra gli OS. In questo studio viene analizzato il trend di adesione vaccinale degli OS operanti presso l’Azienda Ospedaliera Universitaria (AOU) Policlinico di Palermo nelle ultime otto stagioni vaccinali, valutando l’impatto di differenti strategie comunicative ed informative messe in atto nel corso delle ultime tre stagioni vaccinali (2015/2016 - 2016/2017 - 2017/2018) MATERIALI E METODI Gli OS aderenti alla vaccinazione antinfluenzale hanno compilato un questionario validato ed autosomministrato al termine della seduta vaccinale. Contestualmente, è stato predisposto un modulo di dissenso informato per tutti gli OS che non hanno aderito alla vaccinazione antinfluenzale, compilabile sulla pagina personale (intranet) del portale Web Aziendale. Nelle ultime tre stagioni vaccinali sono state messe in atto diverse iniziative atte a promuovere l’adesione alla vaccinazione antinfluenzale degli OS tra cui: creazione di pagine web (internet e social media) dedicate alla campagna vaccinale, creazione di locandine, slogan e hashtag anche in formato cartaceo da utilizzare per promuovere la vaccinazione, settimana di vaccinazione “on site” nei reparti, formazione preliminare degli OS operanti nei reparti a maggiore rischio (UTI, UTIN, Oncologia, Ginecologia, etc...) RISULTATI La copertura vaccinale è salita progressivamente da un valore medio del 5 (dalla stagione 2010/2011 alla 2014/2015) al 27% nell’ultima stagione 2017/2018 (chi-square for trend: 857, p

We investigated the in vitro activities of posaconazole (POS), fluconazole (FLC), amphotericin B (AMB), and caspofungin (CAS) against four clinical isolates of Candida glabrata with various susceptibilities to FLC (FLC MICs ranging from 1.0 to >64 microg/ml). POS MICs ranged from < or =0.03 to 0.5 microg/ml; AMB MICs ranged from 0.25 to 2.0 microg/ml, while CAS MICs ranged from 0.03 to 0.25 microg/ml. When FLC MICs increased, so did POS MICs, although we did not observe any isolate with a POS MIC greater than 0.5 mug/ml. Time-kill experiments showed that POS, FLC, and CAS were fungistatic against all isolates, while AMB at eight times the MIC was fungicidal against three out of four isolates of C. glabrata tested. Then, we investigated the activity of POS in an experimental model of disseminated candidiasis using three different isolates of C. glabrata: one susceptible to FLC (S; FLC MICs ranging from 1.0 to 4.0 microg/ml; POS MIC of < or =0.03 microg/ml), one susceptible in a dose-dependent manner (SDD; FLC MICs ranging from 32 to 64 microg/ml; POS MICs ranging from 0.125 to 0.25 microg/ml), and another one resistant to FLC (R; FLC MIC of >64 microg/ml; POS MIC of 0.5 microg/ml). FLC significantly reduced the kidney burden of mice infected with the S strain (P = 0.0070) but not of those infected with the S-DD and R strains. POS was significantly effective against all three isolates at reducing the kidney fungal burden with respect to the controls (P ranging from 0.0003 to 0.029). In conclusion, our data suggest that POS may be a useful option in the management of systemic infections caused by C. glabrata. Additionally, the new triazole may be a therapeutic option in those cases where an FLC-resistant isolate is found to retain a relatively low POS MIC.

This study adds insight regarding the occurrence and spread of SARS-CoV-2 Variants of Concern (VOCs) and Var-iants of Interest (VOIs) in Italy in October and November 2022, by testing urban wastewater collected through-out the country. A total of 332 wastewater samples were collected from 20 Italian Regions/Autonomous Provinces (APs) within the framework of national SARS-CoV-2 environmental surveillance. Of these, 164 were collected in the first week of October and 168 in the first week of November. A similar to 1600 bp fragment of the spike protein was sequenced by Sanger (for individual samples) and long-read nanopore sequencing (for pooled Region/AP samples).In October, mutations characteristic of Omicron BA.4/BA.5 were detected in the vast majority (91 %) of the samples amplified by Sanger sequencing. A fraction of these sequences (9 %) also displayed the R346T mutation. Despite the low prevalence documented in clinical cases at the time of sampling, amino acid substitutions characteristic of sublineages BQ.1 or BQ.1.1 were detected in 5 % of sequenced samples from four Regions/APs. A significantly higher variability of sequences and variants was documented in November 2022, when the rate of se-quences harbouring mutations of lineages BQ.1 and BQ1.1 increased to 43 %, and the number of Regions/APs positive for the new Omicron subvariant more than tripled (n = 13) compared to October. Moreover, an increase in the number of sequences with the mutation package BA.4/BA.5 + R346T (18 %), as well as the detection of variants never observed before in wastewater in Italy, such as BA.2.75 and XBB.1 (the latter in a Region where no clinical cases asso-ciated with this variant had ever been documented) was recorded.The results suggest that, as predicted by the ECDC, BQ.1/BQ.1.1 is rapidly becoming dominant in late 2022. Environ-mental surveillance proves to be a powerful tool for tracking the spread of SARS-CoV-2 variants/subvariants in the population.

Influenza A and B outbreaks occur each year with different activity and molecular patterns. To date, knowledge of seasonal epidemiology remains a prerequisite not only to put in place the most effective immunization strategy against influenza but also to identify population groups at higher risk of developing serious complications. A retrospective analysis of influenza surveillance data from 2010 to 2018 aimed to explore the epidemiology of influenza in Sicily, at the primary care and hospital level. Overall, 6,740 patients with acute respiratory infection were tested, of which 3,032 (45.0%) were positive for influenza. The relative proportion of type A and B viruses markedly varied across seasons. Type A similarly spreads among children and adults, whereas type B was more commonly identified among pediatric population aged 5–9 years. The median age of confirmed influenza cases differed by health-care setting, increasing according to disease severity (range: 8–54 years). Among influenza-confirmed cases, more than 80% of hospitalized patients had an underlying medical condition. Cardiovascular disease, lung disease, diabetes, and obesity were some of the most frequent. Overall, patients admitted to an intensive care unit were more likely to have multiple comorbidities and being infected with influenza infection strongly increased the risk of severe clinical outcomes. Understanding of the epidemiology of influenza and the molecular features of circulating viruses is of paramount importance to optimize prevention and control strategies. Knowledge of predictors for the occurrence of severe forms of the disease may help to address adequate preventive measures to high-risk population groups.

Are schools triggering the diffusion of the Covid-19? This question is at the core of an extensive debate about the social and long-run costs of stopping the economic activity and human capital accumulation from reducing the contagion. In principle, many confounding factors, such as climate, health system treatment, and other forms of restrictions, may impede disentangling the link between schooling and Covid-19 cases when focusing on a country or regional-level data. This work sheds light on the potential impact of school opening on the upsurge of contagion by combining a weekly panel of geocoded Covid-19 cases in Sicilian census areas with a unique set of school data. The identification of the effect takes advantage of both a spatial and time-variation in school opening, stemming from the flexibility in opening dates determined by a Regional Decree, and by the occurrence of a national referendum, which pulled a set of poll-station schools towards opening earlier or later September 24th. The analysis finds that census areas where schools opened earlier observed a significant and positive increase in the growth rate of Covid-19 cases between 2.5–3.7%. This result is consistent across several specifications, including accounting for several determinants of school opening, such as the number of temporary teachers, Covid-19 cases in August, and pupils with special needs. Finally, the analysis finds lower effects in more densely populated areas, on younger population, and on smaller class size. The results imply that school reopening generated an increase of one third in cases.

Measles is a highly contagious vaccine-preventable disease (VPD) that also commonly affects health-care workers (HCWs). Measles immunization of HCWs was strongly recommended by international health authorities, in order to limit the spreading of the illness to susceptible patients and colleagues. An observational study, evaluating the immunization and vaccination status against measles of HCWs working at three Sicilian university hospitals, was conducted. All subjects not completely immune (vaccinated with only one dose in their lifetime), not immune (not vaccinated or not naturally immunized), and with an unknown immunization status were considered not immunized. Among HCWs operating in the three Sicilian university hospitals, 54.6% were not immune against measles. The average age of not immune HCWs was 51.3 (SD &plusmn, 9.8), ranging between 25 and 71 years old. In particular, 46.9% of HCWs not immunized worked in &ldquo, at-risk&rdquo, hospital units, based on medical conditions of patients which increases the probability of contracting an infection. Vaccination coverage rates observed against measles are considerably lower than other European countries and inadequate. It is therefore crucial to tackle vaccine hesitancy among HCWs, promoting strategies targeted to evaluate immunization status against VPDs and to significantly increase vaccine coverages, such as tailored training and vaccination offer or compulsory vaccination programs.

Fungal infections are an important cause of morbidity and mortality in neonatal intensive care units (NICUs). The identifi-cation of specific risk factors supports pre-vention of candidemia in neonates. Effec-tive prophylactic strategies have recently become available, but the identification and adequate management of high-risk in-fants is still a priority. Prior colonization is a key risk factor for candidemia. For this reason, surveillance studies to monitor in-cidence, species distribution, and antifun-gal susceptibility profiles, are mandatory. Among 520 infants admitted to our NICU between January 2013 and December 2014, 472 (90.77%) were included in the study. Forty-eight out of 472 (10.17%) pa-tients tested positive for Candida spp. (C.), at least on one occasion. All the colonized patients tested positive for the rectal swab, whereas 7 patients also tested positive for the nasal swab. Fifteen out of 472 patients (3.18%) had more than one positive rec-tal or nasal swab during their NICU stay. Moreover, 9 out of 15 patients tested nega-tive at the first sampling, suggesting they acquired Candida spp. during their stay. Twenty-five of forty-eight (52.1%) colo-nized patients carried C.albicans and 15/48 (31.25%) C.parapsilosis. We identified as risk factors for Candida spp. colonization: antibiotic therapy, parenteral nutrition, the use of a central venous catheter, and nasogastric tube. Our experience suggests that effective microbiological surveillance can allow for implementing proper, effec-tive and timely control measures in a high-risk setting.

Introduction. A wastewater-based epidemiology approach was performed to estimate the drug consumption in Palermo city, the fifth largest city of Italy with a population of 671 696 inhabitants, and to investigate the monthly variability of drug loads in wastewater from different areas of the city. A seven-months detection campaign was conducted at the two wastewater treatment plants of the city. Methods. Following a pre-treatment, 32 samples of wastewater were analyzed by liquid chromatography-tandem mass spectrometry. Results. We estimated a mean cocaine use in Palermo of 0.19 g/day/1000 people, corresponding to 1.90 doses/1000 people and cannabinoids use of 2.85 g/day/1000 people, corresponding to 35.62 doses/1000 people. Amphetamines residues in wastewater were always recovered in concentrations lower than the limit of quantification. Conclusion. Our findings showed that drugs consumption in Palermo is in line with those of other Italian cities and that no significant differences on prevalence on cocaine and cannabinoids consumption were recorded in the different months of the survey, except for the summer period in a wastewater treatment plant of the city.

During March 2011 an outbreak of gastroenteritis occurred in Santo Stefano di Quisquina, Agrigento, Sicily, Italy. Within two weeks 156 cases were identified among the 4,965 people living in the municipality. An epidemiological investigation was conducted to characterize the outbreak and target the control measures. A case was defined as a person developing diarrhea or vomiting during February 27–March 13, 2011. Stool specimens were collected from 12 cases. Norovirus (NoV) genotype GII.4 variant New Orleans 2009 was identified in stool samples from 11 of 12 cases tested (91.7%). Epidemiological investigations suggested a possible association with municipal drinking water consumption. Water samples from the public water system were tested for NoV and a variety of genotypes were detected during the first 3 months of surveillance, including GII.4 strains belonging to different variants from that involved in the gastroenteritis outbreak. Contamination of the well and springs supplying the public water network was eventually thought to be the source of the NoV contamination.

Illicit drugs (IDs) and their metabolites have been recently recognized as a new group of water emerging contaminants (ECs) with potent psychoactive properties and unknown effects to the aquatic environment (Pal et al., 2013). IDs are excreted via urine and feces and arrive at wastewater treatment plants (WWTPs) where can reach ppb levels (Castiglioni et al., 2006). Over the past few years, it has been demonstrated that conventional biological processes in WWTPs are not or scarcely able to remove IDs. Thus, they are discharged into water bodies through the treated effluent (Postigo et al., 2011). Therefore, monitoring the IDs concentration in WWTPs can have a twofold advantage: i. increase knowledge on the amount of IDs discharged in the environment and estimate their effect; ii. estimating indirectly the community level consumption (Senta et al., 2014). The objective of this paper is to provide a comprehensive analysis of the occurrence and behaviour of illicit drugs and their metabolites in two Sicilian WWTPs. Specifically, two WWTPs (namely, WWTP-1 and WWTP-2) located at the north-western Sicilian coast have been monitored for 5 months (one sampling per week). The two WWTPs have a conventional scheme and mainly differ for their potentiality. Indeed, the average daily flow expressed as m3d-1 for WWTP-1 and WWTP-2 was equal to 153,600 and 19,704, respectively. Samples were analyzed for total suspended solids (TSS), illicit drugs and their metabolites (metham-phetamine; COC = cocaine; MDMA = 3,4-methylenedioxymethamphetamine; METH = methadone; EDDP = 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine; MDA = 3,4-methylenedioxy amphetamine; MDEA = 3,4-methylenedioxy ethylamphetamine; THC-COOH = 11-nor-9-carboxy-Δ9-tetrahydrocannabinol; BEG= Benzoylecgonine). In order to provide a fast and sensitive approach to quantify IDs, an automated online sample preparation method has been developed. The method uses a Thermo Scientific Transcend TLX-1 system powered by TurboFlowTM technology coupled with a TSQ Quantiva Triple Quadrupole Mass Spectrometer. Specifically, THC-COOH has been extracted from 75 µL of pre-filtered water (using 7 and 0.4 µm paper filters) by an online sample extraction method and quantified using an isotopic dilution approach between 30 and 2000 ng L-1.

• Monitoraggio di droghe in quattro impianti di depurazione siciliani e in un corpo idrico ricettore. • Elevata presenza nei reflui influenti a tutti gli impianti monitorati di THC-COOH e BEG, metaboliti rispettivamente della cannabis e della cocaina. • Fenomeni di degradazione naturale ad opera del biota e/o di accumulo nei sedimenti del corpo idrico ricettore comportano la riduzione delle concentrazione di THC-COOH.

Background: The hairdressing trade may potentially expose its practitioners and their customers to blood-borne infections. Methods: Knowledge, attitudes and behaviours towards occupational risk of HIV, HBV and HCV infections were evaluated in a cross-sectional survey, conducted during spring 2008, in 105 out of 112 randomly selected hairdressers of Palermo. Participants were queried by answering to an anonymous questionnaire. Results: Most of hairdressers (93.3%) knew that HIV and hepatitis are transmitted through parenteral route and could also be transmitted by razors. The availability of gloves was inadequate, up to 30% of the participants never used them and up to 50% usually reused them. In total, 90 respondents stated to perform a sterilization process of the cutting instruments by ultraviolet light, but only 70 sterilized the articles between two customers and only 34.3% executed a daily disinfection of the hair brushes. Statistical analysis showed that younger age and post-primary school instruction were significantly associated with knowledge and procedures that could prevent transmission of blood-borne virus ( P = 0.01 and P < 0.01, respectively). Moreover, only 32 hairdressers agreed to participate to a free specific course on occupational risk offered by the University of Palermo. Conclusion: Although the level of awareness among hairdressers about HIV, hepatitis and risk of transmission was good, there were some unsafe practices that may lead to infections due to blood-borne viruses. The present article highlights the need to improve specific health messages in media campaigns carried out to general population, diffusing more appropriate educational materials for salons and organizing obligatory refresher courses for the hairdressing sector.

Susceptibility testing of anidulafungin (AFG) against 32 mold isolates showed an excellent correlation between disk diffusion (DD) and broth microdilution methods. Based on our data, a 2-μg disk of AFG and a 24-h reading time might represent the best parameters for AFG DD testing against filamentous fungi.

We evaluated the effects of sequential therapy with caspofungin (CAS) or amphotericin B (AMB) followed by posaconazole (POS) against Candida glabrata . The susceptibilities to POS of yeast cells pre-exposed to CAS or AMB were identical to those of untreated cells as shown by standard Clinical and Laboratory Standards Institute broth dilution, cell viability, and disk diffusion methods. We then investigated the activity of sequential regimens in an experimental model of disseminated candidiasis. CAS given at 1 mg/kg/day for 2 days followed by POS at either 15 or 30 mg/kg/day significantly reduced the counts compared to the controls, but this treatment was not superior to the use of CAS alone. Also, sequential regimens with AMB given at 1 mg/kg/day for 2 days followed by POS (AMB/POS) were effective at reducing the fungal burden against the controls. In addition, AMB/POS with both doses of the triazole were significantly more effective than AMB alone. Overall, our data showed that there is no therapeutic advantage in using CAS followed by POS, whereas an induction therapy with AMB followed by a maintenance regimen with POS might be a suitable strategy in managing C. glabrata infections.

Introduction Multidrug-resistant organisms are a serious public health problem, particularly in critical hospital wards such as the Neonatal Intensive Care Units (NICUs). Hospitalized neonates are at high risk for healthcare-associated infections leading to higher morbidity and mortality rates, because of their poor immune defences, frequent exposure to antibiotics, invasive procedures and contacts with healthcare-workers. Our study aimed to evaluate the prevalence of colonization by methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negatives (MDRGNs) and fungi in the five NICUs of the city of Palermo. Methods From February 2014 to January 2015, an active surveillance culture (ACS) program was set up in the five NICUs of Palermo (ARNAS Civico-NICU1, Ingrassia Hospital-NICU2, Villa Sofia-Cervello Hospital-NICU3, Buccheri La Ferla Hospital-NICU4 and AOUP "Paolo Giaccone"-NICU5). From each patient nasal and rectal swabs were monthly collected to look for MRSA, MDRGNs and fungi. Swabs were pre-incubated at 37°C overnight in BHI enrichment broth, and cultured on selective media. Suspected S. aureus colonies were confirmed by cefoxitin susceptibility testing. MDRGNs were selected by antibiotic disk screening and tested to detect extended-spectrum beta-lactamase” (ESBL) and carbapenemase-producing isolates. For fungal detection swabs were directly inoculated on chloramphenicol-Sabouraud dextrose agar plates and incubated at 30°C for 72 hrs. Yeast-like colonies were identified by subculturing on CHROMagar Candida and eventually confirmed by the API20CAUX test. Prevalence rates of colonization of the different NICUs were compared by the chi-square test. Results The average daily number of hospitalized patients was 16 in NICU1, 9 in NICU2, 21 in NICU3, 15 in NICU4, 11 in NICU5. Prevalence of MRSA colonization ranged between 3.6% in NICU3 and 28.8% in NICU4, showing statistically significant differences between the NICUs. Prevalence of colonization by MDRGNs ranged between 53.9% for NICU1 and 14% for NICU4 with statistically significant differences between the NICUs. The most frequently isolated MDRGN organisms were Klebsiella pneumoniae, Escherichia coli and Enterobacter spp., with a prevalence between 1.9% and 57.2% for ESBL-producing and between 0% and 3.5% for carbapenemase-producing isolates. Fungal colonization was never detected in NICU2, whilst the highest prevalence values were 7.2% for C. albicans in NICU4 and 5.9% for non-albicans Candida spp. in NICU5. Statistically significant differences were found. Discussion Spread of multidrug-resistant organisms proved to affect all the NICUs under investigation, with a higher prevalence of MRSA in NICUs 4 and 2 and a higher prevalence of MDRGNs in NICUs 1 and 5. Fungal colonization prevalence was different between the NICUs with NICU4 being more affected by C.albicans and NICU5 by non-albicans Candida spp. These differences could be attributable to different structural and organizational characteristics and the recurrent epidemic spread of some organisms by cross-transmission. The widespread dissemination of MRSA and ESBL producing isolates and the emergence of carbapenem-resistant Enterobacteriaceae require a continuous effort in implementing preventive measures, control interventions and staff training.

We report the detection of one case of co-infection with influenza A(H1N1)pdm09 and B, occurred during the 2012–2013 influenza season in Sicily. The dual infection was identified in a 18-year-old boy, who was not covered by specific vaccination and who had no other pre-existing risk factors. He presented classical symptoms of influenza-like illness developing no respiratory complications. A(H1N1)pdm09 viral concentration was initially about 10-fold higher than B virus, whereas its clearance was more rapidly achieved than in the case of B virus infection. Although influenza co-infection appears to be a rare event, a continued influenza surveillance activity is recommended, in order to evaluate diversity and evolution, but also to support public health prevention measures.

Occult hepatitis B virus (OBI) in HIV-infected groups is still debated, as well as the associated risk-factors and clinical significance. In this paper, we examined a total of 405 HBsAg-negative/HIV-infected patients enrolled from January 2007 to December 2009. Overall, the prevalence of OBI was 5.9% (95% confidence interval (CI95%): 3.8–8.7%); it was more frequently associated with “anti-HBc alone” serological marker (11.3%; adjusted odds ratio = 3.7, CI95%: 1.4–9.8), although it was also detected in the absence of any HBV serological marker (4.9%; CI95%: 2.3–9.1%). A low prevalence of anti-HCV-positive patients with OBI was found (3.1%; CI95%: 0.6–8.7%). HIV RNA plasma levels or other immunological/clinical characteristics were not significantly associated with OBI. All but one occult HBV infections were sustained by genotype D viral strains. OBI is relatively frequent in HIV-infected patients, although it does not seem to exert a relevant clinical impact. Viral genotypes in occult HBV infections reflect those circulating in the Mediterranean area.

HIV-1 subtype B is the most frequent strain in Sicily. To date, there is no available data about the genetic diversity of HIV-1 viral strains circulating in Sicily among antiretroviral (ARV) naive subjects and the role of immigration as potential determinant of evolutionary dynamics of HIV-1 molecular epidemiology. For this purpose, HIV-1 polymerase (pol) sequences obtained from 155 ARV naive individuals from 2004 to 2009 were phylogenetically analysed. The overall rate of HIV-1 non-B infections was 31.0% (n = 48/155), increasing from 7.8% in 2004–2006 to 40.9% in 2009, and about one-third were identified as unique recombinant forms. CRF02_AG was the prevalent non-B clade (n = 28/48, 58.3%), while subtype C-related strains were responsible for about 30% HIV-1 infections. Non-B viruses strictly associated with heterosexual transmission (85.4%) and were mostly found among immigrants (77.1%). Phylogenetic analysis of non-B sequences found in foreign-born subjects was geographically correlated to the respective country of origin. Moreover, the detection of non-B viral variants in the autochthonous population may support an increasing genetic diversity in Sicily as well as a local circulation of HIV strains also uncommon in our country. In Sicily, HIV-1 epidemic is still mostly attributable to the B subtype. Nevertheless, migration and population movements are progressively introducing novel HIV-1 subtypes causing a continuous increase of HIV-1 molecular dynamic at local level. Molecular surveillance is needed to monitor the genetic evolution of HIV-1 epidemic.

In Italy, about 7 % of the resident population is represented by immigrants originating from geographic regions at high endemicity for hepatitis B virus infection. This study aims to assess the prevalence of occult HBV infection (OBI) including the identification of HBV-genotypes in a population of immigrants serologically negative for hepatitis B surface antigen (HBsAg). Between May 2006 and May 2010, 339 immigrants were tested for markers of HBV, hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections. HBV-DNA was tested by using nested-PCR assays on three different genetic region. HBV-DNA was detected in plasma samples of 11/339 (3.2 %) patients. Most of them had no serological markers of HBV infection, 3/58 (5.2 %) were anti-HBc-alone, and 4/13 (30.8 %) were anti-HIV positive. HIV positivity was the only factor independently associated with the higher probability of observing OBI (OR = 16.5, p < 0.001). No HCV co-infected patients were found. Genotype D was detected in 9/11 (81.8 %) OBI cases, while the remaining two (18.2 %) were classified as genotype E. Although OBI was found at lower rate than expected among immigrants from highly endemic countries, anti-HBc alone positivity was confirmed as a sentinel marker of occult HBV infection. Nevertheless, a marked heterogeneity of HBV markers was found among HBV-DNA positive subjects. Our finding evidenced the predominance of HBV-genotype D viral strains among OBI cases, also in those from geographical areas where overt HBV infections are mainly sustained by viral genotypes other than D.

This paper reports on some results of two surveys at sea carried out in the surroundings of a urban wastewater discharge on the coast of the Golfo di Palermo, western Sicily (Italy). At the time of the surveys (year 2005) the stretch of water lying before the central part of the capital town received the untreated wastewater originating from about 200 000 inhabitants, which was discharged on-shore without any prior treatment by the free-surface outfall of “Porta Felice main sewer”. This outfall has crucial importance in the water quality; indeed, the Municipality is steadily implementing a plan featuring an intercepting main sewer along the coast and some pumping stations to connect all the main sewers to the main wastewater treatment plant, located in the SE boundary area of the town. At the moment of the surveys, however, no mitigation measure had been applied yet and the quality of the Gulf was still largely affected by it. Part of the Sanitation Plan was the characterization of the seawater; to this aim, in August and November, 2005, the Università degli Studi di Palermo - on behalf of the Municipality’s Ufficio del Centro Storico - carried out two survey cruises in which the most important seawater quality features were investigated. What will be reported on herein is the part dealing with microbiological indicators, taking the salinity field as background.

The objective of this study was to describe the prevalence of Hepatitis B virus (HBV), Hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections in a cohort of immigrants living in Palermo, Sicily. The study was carried out in the period May 2006-June 2010 and recruited a total of 393 patients (59.8% males-median age of 32.6 years). All patients were tested for serological markers of HBV, HCV, and HIV infection. One-hundred thirty-eight (35.1%) individuals did not show any HBV/HCV/HIV serological marker, while 186 (47.3%) were indicative of past or current HBV infection. A total of 42 (10.7%) subjects were HBsAg positive, 59 (15.0%) showed the serological profile "anti-HBc alone", and only 40 (10.1%) were anti-HBs alone. Overall, 22/393 (5.6%) immigrants were anti-HCV positive and 13/327 (4.0%) were infected with HIV. Findings from this study suggest that a suitable screening protocol for the viral blood/sexually transmissible diseases is recommended on entering Italy, and the adoption of health control strategies should also be considered to safeguard the health of the local population.

Obiettivi Sebbene il subtipo B di HIV-1 sia prevalente in Europa Occidentale, virus ascrivibili ai genotipi non-B stanno rapidamente diffondendosi in questa area geografica, specialmente a causa dai flussi immigratori da regioni endemiche. La Sicilia, vista la sua posizione centrale nel bacino del Mediterraneo, rappresenta una delle principali porte di ingresso per i migranti in Europa, in particolare dall’Europa orientale, dall’Africa e dal sud-est asiatico. L’obiettivo del presente studio è stato valutare la prevalenza, le caratteristiche molecolari e le dinamiche geografiche di varianti virali di HIV-1 non ascrivibili al subtipo B in una coorte di individui infetti non sottoposti a terapia antiretrovirale (ARV), nativi ed immigrati in Sicilia. Metodi Sequenze genetiche della regione polimerasi (pol) di HIV-1 sono state ottenute da un pannello di plasmi consecutivamente prelevati da un totale di 155 pazienti naïve per terapia ARV, 113 nativi italiani e 42 immigrati, in follow-up clinico/virologico presso il Centro di Riferimento Diagnosi AIDS – Università degli Studi di Palermo nel periodo 2004 - 2009. I campioni di plasma, raccolti alla prima visita del paziente, sono stati analizzati per il dosaggio della viremia di HIV-1 e per il successivo sequenziamento genetico e tipizzazione della proteasi (PR, codoni 1-99) e della trascrittasi inversa (RT, 1-335) del gene pol di HIV-1. L’analisi filogenetica è stata applicata per la determinazione del subtipo di appartenenza e per la valutazione delle relazioni geografiche tra varianti virali di HIV-1. Risultati Nella popolazione in studio (72.3% maschi; età mediana 34.0 anni; range 1 - 66), la prevalenza di ceppi non-B di HIV-1 era del 31.0% (48/155) con un incremento dall’11.5% nel 2004-2006 al 40.9% nel 2009 (p=0,025). La maggior parte delle varianti virali identificate erano rappresentate da forme ricombinanti uniche (URF) (range: 56% - 100% delle varianti non-B). Delle varianti virali classificabili come HIV-1 non-B, il 77.1% (37/48) infettava individui immigrati (prevalentemente africani, 35/37), mentre il 22.9% (11/48) proveniva da pazienti nativi italiani (p

Il mare copre il nostro pianeta per circa il 71% della superficie terrestre e gioca un ruolo fondamentale nella vita dell’uomo. Le acque marine sono connesse con la Sanità Pubblica a vari livelli, infatti sia lo stato di salute e benessere individuale che di popolazione risulta influenzato dalle condizioni del mare e delle sue risorse in maniera positiva o negativa. Milioni di individui ogni anno in Italia, per attività balneare ricreativa, si concentrano per periodi relativamente ristretti in litorali più o meno estesi spesso ubicati in diretta continuità con le realtà urbane e metropolitane di fatto determinando un potenziale ambito di contatto tra le attività antropiche e lo smaltimento dei reflui fognari cittadini. Nell’ambito della relazione saranno pertanto analizzati i principali aspetti igienicosanitari della recente normativa sulle acque di balneazione, derivanti dall’applicazione del D.lgs 116/08 anche in relazione alla precedente normativa (DPR 470/82). Inoltre la qualità delle acque marine costiere è stata oggetto della “Water Framework Directive” in applicazione della Direttiva 2000/60/CE improntata all’esigenza di fissare i principi di base di una politica sostenibile in materia di acque a livello UE, con l’obiettivo del raggiungimento del ‘buono stato ecologico’ entro il 2015. Le risorse biologiche marine costituiscono una fonte essenziale di sostentamento. Ma il mare è anche “un evento terapeutico” e risorsa di enorme interesse nel campo della ricerca biomedica marina. È noto come alcuni organismi marini producano sostanze bioattive provviste di numerose proprietà farmacologiche utili per il trattamento di patologie e come altre risorse biologiche marine abbiano capacità antibiotiche e antitumorali. Se questa è già una realtà, la ricerca su alcuni organismi marini prospetta per il futuro una nuova gamma di insperate possibilità per la salute dell’uomo.

OBIETTIVI: Valutazione della qualità microbiologica dell’aria nelle sale operatorie dell’A.O.U.P. “P. Giaccone” di Palermo mediante metodi di campionamento attivo e passivo. MATERIALI: Nel secondo semestre del 2009 sono stati effettuati campionamenti di aria in 20 sale operatorie (10 a flusso laminare e 10 a flusso turbolento) sia in condizioni di attività sia in condizioni di riposo. I punti di prelievo per il campionamento attivo sono stati: 1) il centro stanza 2) il VCCC; per il campionamento passivo 1) centro stanza 2) fondo stanza. Sono stati monitorati i seguenti parametri: carica batterica totale (CBT), carica micetica totale (CMT), Staphilococcus aureus ed Indice Microbico Aria (IMA) per batteri e miceti. I microrganismi isolati sono stati oggetto di identificazione. I dati ottenuti sono stati elaborati con EpiInfo 3.5.1. RIASSUNTO: Il campionamento attivo ha rilevato CBT pari a 87,7±65,7 CFU/m3 e CMT pari a 0,8±1,5 CFU/m3 nel centro stanza mentre nel VCCC sono state rilevate CBT pari a 16,5±22,2 CFU/m3 e CMT pari a 0,8±1,1 CFU/m3. Il campionamento passivo durante le attività chirurgiche ha mostrato valori IMA pari a 19,8±13,5 per batteri e 0,1±0,3 per miceti nel centro stanza, mentre nel fondo stanza valori IMA pari a 16,7±13 per batteri e 0,6±1 per miceti. In assenza di attività, si sono rilevati valori IMA pari a 3,9±3,9 per batteri e 0,1±0,2 per miceti nel centro stanza mentre nel fondo stanza valori IMA pari a 2,4±3,1 per batteri e 0,2±0,4 per miceti. In nessun campione è stato rilevata la presenza di S. aureus. Le muffe isolate, rilevate con maggiore frequenza nel campionamento attivo, sono state Cephalosporium spp, Aspergillus spp e Pennicillum spp. L’elaborazione dei dati ha evidenziato che soltanto le conte batteriche rilevate con entrambi i metodi di campionamento sono risultate tra loro significativamente correlate (p

In a previous study we evaluated the microbiological quality of water of seven pools in the city of Palermo through evaluation of bacterial indicators of faecal contamination and of protozoa (Giardia and Cryptosporidium). In this study we also searched for the presence of fungi in two swimming pools of a public swimming facility in the same city. Samples were collected from both pools, their filtration systems and floor surfaces of the facility. Chemical-physical and microbiological examination of water of the two pools have shown that quality of water depends on the concentration of residual free chlorine and on the number of bathers in the pool. The values of four microbiological parameters (bacterial load at 22 degrees C and 36 degrees C, presence of coagulase-negative Staphylococci and Pseudomonas spp.) increased with diminishing chlorine concentrations and with increasing number of pool users. Faecal bacteria, Giardia and Cryptosporidium were not found. On the other hand, various fungi were isolated from floor surfaces and pool water even in the presence of optimal chlorine concentrations. This study confirms the importance of regular maintenance of pool disinfection systems and suggests the need to search for other micro-organisms not included in the current legislation (Giardia, Cryptosporidium and fungi).

The aim of this study was to identify whether the origin of Oreto river Giardia contamination was derived from one of the influents, which flows near Monreale city and receives its treated wastewater, or from livestock living in farms along the river. Genotypes were characterized by DNA sequencing analysis of PCR products of TPI gene. 17 water samples coming from Oreto basin, 20 fecal animal samples and 7 human fecal samples from 3 patients with giardiasis were processed. Cysts were typed as assemblage A (n=11), B (n=2) and A+B (n=4) in water samples, as assemblage A (n=4) and B (n=2) in human samples, while in livestock was found only assemblage E. Subtype AII was prevalent in both water and human samples. This work suggests the need to increase the efficacy of wastewater treatment in order to avoid any further river contamination.

Predicting the clinical outcome of a systemic mycosis is often a difficult task, especially when microbiological resistance is one of the factors contributing to therapeutic failure. Some of these factors are host-related--e.g. immune state, site and severity of infection, poor compliance to therapy--while others are associated with the drug's characteristics--e.g. dosage, type of compound (fungistatic/fungicidal), pharmacokinetic properties and drug-drug interactions. In the last few years, clinicians have been confronted with the problem of selecting the most appropriate antifungal therapy for systemic infections and have highlighted the need for a reliable method to assay the in vitro susceptibility of yeasts and molds to different antifungal agents, which would allow them to institute a tailored therapy. Using the CLSI micromethod--the reference method for clinically relevant yeast testing--we assayed 70 clinical yeast isolates ( Candida spp., collected from patients with systemic mycosis) for susceptibility against fluconazole, voriconazole and caspofungin. Data obtained from our in vitro susceptibility assays revealed good activity of azoles against the majority of Candida spp. In particular, 88.6% of the assayed isolates were susceptible to fluconazole, with minimum inhibitory concentrations (MICs) ranging from =0.125 microg/mL to 8 microg/mL; 97.1% of the isolates were susceptible to voriconazole, with MICs ranging from 0.008 microg/mL to 1 microg/mL; regarding caspofungin 72.9% of the isolates had MICs ranging from 0.25 microg/mL to 1 microg/mL.

This paper reports the investigation carried out on the occurrence of Cryptosporidium and Giardia (oo)cysts in water samples of two municipal treatment plants, and in surface water and ground water wells of the province of Palermo. The wastewater samples taken before and after treatment process were assayed over the course of one year Giardia cysts were detected in all samples throught the year at higher concentration levels than Cryptosporidium oocysts, with a peak observed in spring. The overall removal efficiency of (oo)cysts in the treatment plants was about of 90%. Their presence were also searched in surface waters (three artificial lakes and one river); (oo)cysts were detected in one lake at very low concentration; on the contrary, both parasites were found at high concentration levels in all the samples collected throught one year from the water of the river. The pattern of occurrence of both parasites appears temporally related to the level of rainfall trend. Cryptosporidium and Giardia were also found in ground water wells; their presence occurred only in waters taken from wells at a depth lower than 31 meters with concomitant presence of faecal bacteria. These results may provide further insight into the possible source of Cryptosporidium and Giardia in natural environmental and stress the potential risk associated with the use of waters for recreational and agricultural purposes.

This paper describes the epidemiology of hospitalised cases with influenza-like illness (ILI) and laboratory- confirmed influenza A cases in Sicily (Italy) during the 2009 influenza pandemic. The first ILI case diagnosed as infected with pandemic influenza A(H1N1)2009 in Sicily was reported in June 2009 and it rapidly became the dominant circulating strain. In the period from 30 April 2009 through 31 December 2010, a total of 2,636 people in Sicily were hospitalised for ILI and 1,193 were laboratory-confirmed for influenza A. Basic demo- graphic and clinical information for all hospitalised patients was collected and population mortality rates (PMRs) and case fatality ratios (CFRs) were calculated. The median age of hospitalised patients infected with pandemic influenza A(H1N1)2009 was significantly lower than that of hospitalised ILI cases in general (18.0 vs. 32.1 years; p

SYNTHESIS AND ANTIMICROBIAL ACTIVITY OF NEW 1-R-3-(2-PIRIDYL)- 4-NITROSO- 5-CARBOXIETHYL-1H-PYRAZOLES. Stefania Aielloa , Carmelo Massimo Maidab, Fabio Venturellab, Diego Planetac Marco Giammancod, M.Milicib a Dipartimento di Scienze e Tecnologie Molecolari e Biomolecolari, Università degli Studi di Palermo bDipartimento di Scienze per la Promozione della Salute G. D’ Alessandro, Università degli Studi di Palermo cDipartimento dei Sistemi Agro-Abientali,Università degli Studi di Palermo d Dipartimednto di Studi Giuridici, Economici, Biomedici e Psicosociopedagogici delle Scienze Motorie e Sportive, Università degli Studi di Palermo Corresponding author: Stefania Aiello, Dipartimento di Scienze e Tecnologie Molecolari e Biomolecolari, Università degli Studi di Palermo, Via Archirafi 32, 90123 Palermo, Italy; tel:+39.091 23896802; email: stefania.aiello@unipa.it In recent years, epidemiological studies confirm the significant impact on human health by infections caused by pathogenic fungi. In fact, although the Candida genus is commensal and a constituent of the normal gut flora, it is responsible for opportunistic infections and can become pathogenic secondary to predisposing factors related to the host, like a comprimised immune system (AIDS, anti-cancer therapy, transplants), excessive prophylaxis with antimicrobial agents, and use of invasive catheters. Large-scale surveillance for fungal infections has demonstrated an increasing incidence of drug-resistant fungal pathogens. As a matter of fact, a significant number of fungi species (especially Candida glabrata and Candida krusei) exhibited primary resistance to Fluconazole or were less susceptible to Amphotericin B. Furthermore, as a consequence of the toxicity of the currently used polyene antifungal drugs, which leads to interrupt the therapy, and the emergence of Candida species resistance to azole-based agents, there is an urgent need for developing alternative drug therapies. In our previous study we have disclosed the synthesis and antifungal activity of a series of 4-nitrosopyrazoles that mainly displayed in vitro potent antifungal activity at no cytotoxic concentrations and that some of these compounds were 4 times more potent than Amphotericine B and Fluconazole respectively against Cryptococcus neoformans and Candida Krusei [1-4] As part of our Structure Activity Relationships studies, we were interested in learning the influence of the steric and electronic effects of the substituent in position 5 of the 4-nitrosopyrazoles which had already showed powerful antimycotic activity. Therefore, we synthetized title compounds and evaluated their antimycotic activity (fig1). NNNCOOC2H5ONR R: a=H, b= CH3, c=C2H5 Fig 1. Synthetized compounds The 5-carboxiethylester group has made the antimycotic actity dramatically decay, confirming the necessity, for a good antimicotic activity, of derivatives in which the position 5 is free or substituted with little groups as a methyl shown the best antifungal activity. [1] E. Aiello, S. Aiello, F. Mingoia, A. Bacchi, G. Pelizzi, C. Musiu, M. G. Setzu, A. Pani, P. La Colla and M. E. Marongiu. Synthesis and Antimicrobial activity of New 3-(1-R -3-methyl-4-nitroso-1H-5-pyrazolyl)-5-methylisoxazole derivatives, Bioorganic and Medicinal Chemistry, 2000, 8, 2719-2728 [2] Stefania Aiello; Enrico Aiello, Marica Orioli, Marina Carini, 3-(1-R-3-methyl-4-nitroso-1H-5-pyrazolyl)-5-methylisoxazoles: a new class of antifungal compounds. In vitro metabolism by rat liver:LC and LC-MS studies. Convegno Nazionale, Sorrento 18-22 Settembre 2002. [3] S. Aiello, E. Aiello and M. Milici: “Synthesis and Antifungal Activity of new 3(5)-methyl-5(3)-(2-thiophenyl) and -(2-quinolyl)-1H-1-R-4-nitrosopyrazoles.Part V”. Polish-Austrian-German-Hungarian-Italian Joint Meeting on Medicinal Chemistry, Krakow, October 15-18, 2003 [4] Stefania Aiello, Antonio Macchiarulo, Maria Milici and Enrico Aiello, Sintesi e studi QSAR di nuovi derivati 3(5)-(2-X)-1R-1H-4-nitrosopirazoli: una classe di composti con potente attività antifungina in vitro. Parte VI XVII Convegno Nazionale della Divisione di Chimica Farmaceutica della SCI, Pisa 6-10 settembre 2004.

Background Air pollution from vehicular traffic has been associated with respiratory diseases. In Palermo, the largest metropolitan area in Sicily, urban air pollution is mainly addressed to traffic-related pollution because of lack of industrial settlements, and the presence of a temperate climate that contribute to the limited use of domestic heating plants. This study aimed to investigate the association between traffic-related air pollution and emergency room admissions for acute respiratory symptoms. Methods From January 2004 through December 2007, air pollutant concentrations and emergency room visits were collected for a case-crossover study conducted in Palermo, Sicily. Risk estimates of short-term exposures to particulate matter and gaseous ambient pollutants including carbon monoxide, nitrogen dioxide, and sulfur dioxide were calculated by using a conditional logistic regression analysis. Results Emergency departments provided data on 48,519 visits for respiratory symptoms. Adjusted case-crossover analyses revealed stronger effects in the warm season for the most part of the pollutants considered, with a positive association for PM10 (odds ratio = 1.039, 95% confidence interval: 1.020 - 1.059), SO2 (OR = 1.068, 95% CI: 1.014 - 1.126), nitrogen dioxide (NO2: OR = 1.043, 95% CI: 1.021 - 1.065), and CO (OR = 1.128, 95% CI: 1.074 - 1.184), especially among females (according to an increase of 10 μg/m3 in PM10, NO2, SO2, and 1 mg/m3 in CO exposure). A positive association was observed either in warm or in cold season only for PM10. Conclusions Our findings suggest that, in our setting, exposure to ambient levels of air pollution is an important determinant of emergency room (ER) visits for acute respiratory symptoms, particularly during the warm season. ER admittance may be considered a good proxy to evaluate the adverse effects of air pollution on respiratory health.

Background: The presence of Giardia was investigated along the Oreto river between January 2008 and May 2009 with the aim of understanding the source of contamination by molecular typing of cysts.Methods: A total of 38 water samples (10 collected from the river mouth, 24 from the whole Oreto basin and 4 sewage samples from the Monreale treatment plant) were processed. In addition, 22 faecal samples of livestock living close to the Oreto area, were analyzed. The presence of Giardia was determined by immunofluorescence assay and their genetic characterization was achieved by a nested PCR assay targeting the triosephosphate isomerase gene. Results: All water samples from the river mouth were positive for Giardia, even if the concentration of cysts fluctuated considerably among sampling occasions. Our investigation showed that the Vadduneddu and Altofonte torrents, two influents of the river, were the principal sources of contamination. Moreover, the genotypes of Vadduneddu torrent were the same as those detected in human wastewater taken from the activated sludge plant of Monreale city. Assemblages A and B were found in water samples with a predominance of Assemblage A, subtype AII. Assemblage E was only found in a single calf isolate. Conclusions: The data show that the high cyst counts regularly detected in the Oreto river are due to contamination with wastewater of human origin. This finding is relevant for public health, particularly because river water is used for agricultural purposes.