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Salmonellosis is become an increasing public health problem in many countries. Serotyping and assessment of antibiotic resistance are useful tools, which assist in understanding the epidemiology of Salmonella infections. In this respect, the Centre of Enterobacteriaceae of Southern Italy provides helpful information on the changing pattern of Salmonella serovars in this geographic area. This paper reports the distribution of serovars and their antibiotic susceptibility in the years 1983-1987. In particular, because of their peculiar trends during this 5-year period, epidemiological features of Mbandaka, Corvallis, Dublin, Infantis and Wien serovars are described.

SUMMARYA molecular epidemiological study was carried out on 60Salmonella dublinisolates identified at the Southern Italy Enterobacteriaceae Center between 1971 and 1985. These included 23 isolates from children with diarrhoea in Palermo obtained during 1984.All isolates from the outbreak of gastroenteritis in children were resistant to chloramphenicol and streptomycin and harboured two plasmids of 50 MDa and 3 MDa molecular weight, whereas the majority of the isolates identified before 1984 were susceptible to these antibiotics and carried only a 50 MDa molecular weight plasmid. FourS. dublinstrains successively identified from cattle (Palermo, Foggia, Portici) and from a child (Palermo) were shown to possess similar antibiotic resistance patterns and plasmid profiles toS. dublinisolates from the outbreak of gastroenteritis in children.The 50 MDa plasmid was shown to be associated with virulence in mice, while it was not possible to assign any genetic function to the 3 MDa plasmid.

A longitudinal study to ascertain the most common therapeutic approach to diarrheal disease by general practitioners and pediatricians was carried out in Western Sicily. Data obtained showed that of 902 home-managed cases of diarrhea observed by 58 physicians during one year, 65.3% were treated with antibiotics, 8.0% with antimotility agents and 26.7% were not treated with any pharmacological agent (rehydration or diet). Although oral rehydration therapy was widely known by physicians in Western Sicily, only a few of them were willing to use it routinely as the principal and exclusive treatment.

Background: The Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health conducted a multicentre survey aiming to evaluate undergraduate health care students’ knowledge of tuberculosis and tuberculosis control measures in Italy. Methods: In October 2012–June 2013, a sample of medical and nursing students from 15 Italian universities were enrolled on a voluntary basis and asked to complete an anonymous questionnaire investigating both general knowledge of tuberculosis (aetiology, clinical presentation, outcome, screening methods) and personal experiences and practices related to tuberculosis prevention. Data were analysed through multivariable regression using Stata software. Results: The sample consisted of 2,220 students in nursing (72.6%) and medicine (27.4%) courses. Our findings clearly showed that medical students had a better knowledge of tuberculosis than did nursing students. Although the vast majority of the sample (up to 95%) answered questions about tuberculosis aetiology correctly, only 60% of the students gave the correct responses regarding clinical aspects and vaccine details. Overall, 66.9% of the students had been screened for tuberculosis, but less than 20% of those with a negative result on the tuberculin skin test were vaccinated. Multivariable regression analysis showed that age and type of study programme (nursing vs. medical course) were determinants of answering the questions correctly. Conclusions: Although our data showed sufficient knowledge on tuberculosis, this survey underlines the considerable need for improvement in knowledge about the disease, especially among nursing students. In light of the scientific recommendations concerning tuberculosis knowledge among students, progress of current health care curricula aimed to develop students’ skills in this field is needed.

Nasal turbinate hypertrophy is a major cause of nasal airway obstruction that affects up to 20% of the European general population. This study aims to determine the efficacy of radiofrequency treatment as perceived by patients during a 2-years period. From 2007 to 2009, an observational study was conducted on 36 patients who consecutively underwent temperature-controlled radiofrequency tissue volume reduction. A questionnaire was administered to each patient in order to collect demographic data, lifestyle habits, health status and visual analogue scale (VAS) score of perceived symptoms. Mean VAS scores of nasal obstruction, headache, rhinorrhoea and anosmia after treatment were significantly lower than that at baseline. Urban residence and allergic rhinitis were significantly associated with lower mean improvement (2.9 vs. 5.6; P = 0.04 and 2.3 vs. 5.3; P = 0.01, respectively). A non significant association with scarce nasal obstruction improvement was present in older aged patients, in patients other than students and in active and passive smokers. Our data enrich the general knowledge on radiofrequency treatment of turbinate hypertrophy identifying the rate of long-term efficacy of radiofrequency treatment as perceived by patients and focusing on several risk factors involved in patient prognosis after treatment.

BACKGROUND:Endothelial dysfunction is involved in the pathogenesis of atherosclerosis. Consumption of fish is associated with reduced cardiovascular risk, but there is paucity of data concerning its effect on endothelial function. Furthermore, investigation of the effects of fish consumption on health must take into account the ingestion of contaminants, including transition metals and some metalloids, which may have unfavorable effects on health, including those on the cardiovascular system. We investigated the association between fish consumption, endothelial function (flow mediated dilation of the brachial artery), and serum concentration of some toxic metals in apparently healthy people. METHODS:Twenty-nine high fish consumers (at least 3 portions a week) were compared with 25 low fish consumers (less than 1 portion a week). All participants were free of diabetes, cardiovascular or other systemic diseases. Serum metal (antimonium, arsenic, mercury, lead, cobalt, copper, zinc, selenium, strontium) concentrations were measured in subgroups of 24 high fish consumers and 19 low fish consumers. RESULTS:Both groups exhibited similar habitual dietary patterns, age and anthropometric characteristics. The high fish consumers had higher flow mediated dilation (9.7 ± 1.8 vs. 7.3 ± 1.9%; P

Background The use of diuretics for hypertension has been associated with unfavorable changes in cardiovascular risk factors, such as uric acid and glucose tolerance, though the findings in the literature are contradictory. Methods This study investigated whether diuretic use is associated with markers of metabolic and cardiovascular risk, such as insulin-resistance and uric acid, in a cohort of adults without known diabetes and/or atherosclerotic cardiovascular disease. Nine hundred sixty-nine randomly selected participants answered a questionnaire on clinical history and dietary habits. Laboratory blood measurements were obtained in 507 participants. Results Previously undiagnosed type 2 diabetes was recognized in 4.2% of participants who were on diuretics (n = 71), and in 2% of those who were not (n = 890; P = 0.53). Pre-diabetes was diagnosed in 38% of patients who were on diuretics, and in 17.4% (P

Parallel to the increase in obesity, the prevalence of metabolic syndrome (MetS) is continually increasing, with increased risk of diabetes and cardiovascular atherosclerosis diseases. Despite the importance of this public health problem, the relative impact of diet and physical activity on MetS prevalence has yet to be established. We investigated the association between lifestyle, in terms of both habitual dietary pattern and physical activity, and MetS in a cohort of adults without known diabetes and atherosclerotic cardiovascular disease. Four hundred seventy-seven randomly selected adult participants were cross-sectionally investigated. Each participant answered a food frequency questionnaire and a questionnaire on physical activity, and underwent routine laboratory blood measurements. MetS was identified in 24.7 % of the cohort. Dietary patterns were not significantly different (P = 0.31) between the groups (with or without MetS). The habitual physical activity level was significantly lower (P = 0.011) in the group with MetS. In particular, the prevalence of sedentary participants was 58.1 % in the group with MetS, and 43.9 % in the group without MetS. Multivariate analysis revealed that MetS was associated with age (OR = 1.06, 95 % CI 1.03–1.08) and physical activity level (light vs. sedentary: OR = 0.53, 95 % CI 0.32–0.87; moderate/heavy vs. sedentary: OR = 0.31, 95 % CI 0.13–0.75). This study suggests that inadequate physical activity level is associated with MetS. Our results are therefore consonant with the notion of healthier lifestyle changes to counteract the epidemic of diabetes and cardiovascular disease, though adequate interventional trials will be needed in high-risk populations.

Street food (SF) is defined as out-of-home food consumption, and generally consists of energy-dense meals rich in saturated fats and poor in fibers, vitamins and antioxidants. Though SF consumption may have unfavorable metabolic and cardiovascular effects, its possible association with atherosclerosis has not been considered. The association between habitual SF consumption and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness, was therefore investigated. One thousand thirty-five randomly selected adult participants without known diabetes and atherosclerotic cardiovascular diseases were cross-sectionally investigated in Palermo, Italy. Each participant answered a food frequency questionnaire and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Laboratory blood measurements were obtained in a subsample of 541 participants. A score of SF consumption was obtained by categorizing each of ten SFs consumed more or less than once a month. Participants were divided into three classes based on the tertiles of SF score distribution. Age, gender distribution, body mass index (BMI), prevalence of hypertension and of clinically silent carotid atherosclerosis (I tertile 20.8 %, II tertile 19.7 %, III tertile 19.0 %; P = 0.85) were not significantly different among the three groups. Clinically silent carotid atherosclerosis was independently associated with age, gender and hypertension. The score of SF consumption was significantly correlated with BMI (r = 0.10; P = 0.04), uric acid (r = 0.16; P = 0.002) and high-density lipoproteins-cholesterol (r = −0.13; P = 0.009) blood concentrations. In conclusion, this study suggests that SF consumption is not associated with clinically silent carotid atherosclerosis. However, given the association of SF consumption with other cardiovascular risk factors, caution requires that this category of food should be limited in patients at high cardiovascular risk.

BACKGROUND/OBJECTIVES:Dietary habits are important determinants of individual cardiovascular and metabolic risk. This study investigated the association between dietary patterns and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness, and metabolic biomarkers of insulin resistance, including the homeostasis model assessment of insulin resistance (HOMA-IR) and the trygliceride/high-density lipoprotein (HDL)-cholesterol (Tg/HDL) ratio in a cohort of adults without known diabetes or atherosclerotic cardiovascular disease.SUBJECTS/METHODS:Nine hundred and twenty-nine randomly selected participants were cross-sectionally investigated. Each participant answered a food frequency questionnaire, and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Laboratory blood measurements were obtained in a subsample of 507 participants.RESULTS:A dietary pattern that could be defined as unhealthy (high consumption of soft drinks, fried foods, seed oils, cured meats, butter, red meat and sweets) was identified in 21% of the cohort, whereas 34% of the cohort exhibited a dietary pattern that resembled the Mediterranean diet (high intakes of fruit, milk and cheese, olive oil, vegetables, pasta and bread). Intermediate habits characterized the remaining 45%. After adjusting for age, body mass index (BMI), waist circumference, glycated hemoglobin (HbA1c) and hypertension on treatment, the Mediterranean dietary pattern was associated with significantly lower HOMA-IR (β-coefficient=-0.51; P=0.003). After adjusting for gender, BMI and HbA1c, the unhealthy dietary pattern was associated with a significantly higher Tg/HDL-cholesterol ratio (β-coefficient=0.43; P=0.006). No significant association was found between dietary patterns and carotid atherosclerosis.CONCLUSIONS:This study suggests that, independent of measures of adiposity, a Mediterranean dietary pattern is associated with lower insulin resistance.

Summary Background Although guidelines for antibiotic prophylaxis to prevent surgical site infections (SSIs) exist, specific guidelines for plastic surgery are missing and there is a tendency towards excessive administration of antibiotics. A total of 1100 patients were prospectively studied according to an evidence-based protocol to investigate if limiting antibiotic prophylaxis to high-risk cases does increase the infection rate. Methods Between April 2009 and April 2010, 1100 consecutive patients undergoing elective reconstructive or cosmetic procedures were enrolled. Procedures were classified into four groups, and prophylactic antibiotics were only administered perioperatively in 23.4% of cases, according to patient-related and procedure-related risk factors. Results The overall SSI incidence was 1.4% (1.1% for clean surgery and 3.8% for clean-contaminated surgery). Oral oncologic surgery showed the highest infection rate (5.3%). Conclusions Specific guidelines are provided to encourage judicious use of antibiotics. Antibiotic prophylaxis is administered based on the type of operation and the patient's characteristics. No prophylaxis was carried out in superficial skin surgery and simple mucosal excisions. Antibiotic prophylaxis is always indicated in microsurgery, prosthetic surgery, incisional hernias, clean non-prosthetic osteoarticular surgery and clean-contaminated procedures such as oral cavity or genitourinary system. In clean surgery and rhinoplasty, antibiotic prophylaxis is only indicated when the operation lasts more than 3 h and/or the American Society of Anesthesiologists (ASA) score is 3 or more. With the protocol reported, the risk of infection can be kept very low, avoiding the negative effects of indiscriminate use of antibiotics.

Background: although the epidemiological features of overweight and obesity have been well described, especially for very populous urban areas, less evidences are available for small urban areas. The aim of the present work was to assess BMI and factors associated with overweight and obesity in a representative sample of general population of a small city of Western Sicily (Italy). Methods: four hundred and eleven randomly selected adult subjects from general population living in a small Sicilian city with 7 144 inhabitants were interviewed by a standardized questionnaire investigating life-styles, eating habits, anthropometric measurements (weight, height and BMI) and socio-economic deprivation. Results: the standardized prevalence of overweight and obesity were 43.8% and 18.3%, respectively. The multivariate analysis has indicated an increased risk of BMI≥25 in subjects 40-59 years old (OR=2.3; 95% CI=1.2-4.4) in comparison with 18-39 years old, in males (OR=2.8; 95% CI=1.6-4.7) in comparison with females, and in participants who had a higher socio-economic deprivation (OR=1.3; 95% CI=1.1-1.7). ConclusionS: in small urban areas some demographic factors and socio-economic deprivation can be considered important risk factors for increased BMI also after controlling for the most common confounding factors.

Polymorphisms of genes encoding key factors for the control and activation of inflammatory response and coagulation cascade regulation may play a role in genetic susceptibility to acute myocardial infarction (AMI). This study sought to analyze the effect of TNF - 308G/A and pro-thrombin (FII) 20210G/A polymorphisms on the laboratory parameters of young patients affected by AMI. Results indicated that TNF - 308A positive genotype frequencies were increased in these patients and that a genetically determined higher production of TNF-alpha is associated in young subjects to a more severe cardiac damage as depicted by higher levels of troponin, Creatine kinase-MB Isoenzyme (mCK-MB) and a significant increased plasma fibrinogen levels. Similar and probably additive effects on might have a genetically determined increased production of pro-thrombin even if no significant differences in genotype frequencies of pro-thrombin (FII) 20210G/A polymorphisms were observed in this study. All together these results, indicating the relationship among genetically determined TNF alpha and FII production and increased levels of tissue damage markers of AMI, suggest that a complex genetic background, might be involved in susceptibility to AMI in young men influencing the extension and severity of the disease.

Polychlorinated biphenyls (PCBs) and organochlorine pesticides are common environmental contaminants that have been associated with human health problems. OBJECTIVES: To assess serum concentrations of several organochlorine contaminants in general population living in a city with an ancient agricultural tradition and to identify possible exposure sources in Sicily. METHODS: A cross-sectional study was conducted on 101 individuals. Each participant answered a face-to-face questionnaire submitted by well-trained personnel and provided a serum sample which was analyzed for the concentrations of PCBs, HCB, HCHs and DDTs by using gas-chromatography coupled with mass spectrometry. RESULTS: HCB, p,p'-DDE, PCB 138, PCB 153 and PCB 180 were detected in more than 80% of the study participants. The ngg(-1) lipid median concentrations were: 18.6 for HCB; 175.1 for p,p'-DDE; 22. for PCB 138; 32.5 for PCB 153 and 23.0 for PCB 180. PCB 153 and PCB 138, PCB 138 and PCB 180, PCB 153 and PCB 180, and p,p'-DDE and HCB showed a high correlation each other (p49years old (adj-p=0.03 in 50-69years old and adj-p69years old, respectively) whereas PCB 138, PCB 153 and PCB 180 concentrations were higher in males (adj-p=0.03), in subjects >69years old (adj-p=0.04) and in current smokers (adj-p=0.04). CONCLUSIONS: The present study shows that serum concentrations of organochlorine compounds detected in subjects living in a small Sicilian city with ancient agricultural tradition are similar to those found in subjects living in urban areas of other countries. However, further investigations are needed to compare data from rural/urban areas in the same country, assessing correlations between serum concentrations of several chemical compounds and potential health effects in general population.

Background Genotype 1 (G1) hepatitis C virus (HCV) is associated with insulin resistance (IR) and its clearance seems to improve insulin sensitivity. We aimed to evaluate the time course of IR in response to antiviral therapy in non-diabetic, non-cirrhotic G1 HCV patients and to assess the effect of metabolic factors on sustained virological response (SVR). Methods A total of 83 consecutive treatment-naive G1 chronic hepatitis C (CHC) patients were evaluated by anthropometric and metabolic measurements, including IR using the homeostasis model assessment (HOMA). Patients were considered to have IR if HOMA was >2.7. All cases had a liver biopsy scored for staging, grading and steatosis. Anthropometric parameters and HOMA were re-evaluated at the end of antiviral therapy and at follow-up. Results SVR was achieved in 46 (55.4%) patients. By logistic regression, female gender (odds ratio [OR] 0.132, 95% confidence interval [CI] 0.33–0.529), γ-glutamyltransferase >50 IU (OR 0.217, 95% CI 0.066–0.720) and presence of steatosis (OR 0.134, 95% CI 0.028–0.654) were independent negative predictors of SVR, whereas low-density lipoprotein cholesterol >107 IU (OR 6.671, 95% CI 1.164–11.577) was a positive predictor of SVR. The proportion of patients with IR significantly decreased ( P=0.02) during antiviral therapy and at follow-up in patients achieving SVR. A similar trend, even if not significant, was observed in relapsers and non-responders. Conclusions In non-diabetic G1 HCV patients undergoing antiviral therapy, IR improved in all patients, independently of virological outcome. HCV viral clearance was an additional factor in IR improvement. Female gender, hepatic steatosis and other metabolic parameters, but not IR, were identified as negative predictors of SVR in this study.

The objective of this study was to assess the prevalence of odontogenic cysts (OCs) in Sicily and evaluate their distribution during a 20-year period. A cross-sectional retrospective study was carried out in 1,310 cysts of the jaw diagnosed in 12,197 individuals, who consecutively attended the Odontostomatologic Clinic of Palermo from 1986 to 2005. 1,273 cysts were classified as odontogenic, whereas only 37 were non-odontogenic. In the former group, the most frequent lesions were radicular cysts (84.5%), followed by dentigerous OCs (11.4%). Inflammatory radicular cysts were observed more in male gender, younger age at diagnosis and anterior maxilla as site of presentation. Unlike dentigerous cysts, the frequency of radicular cysts decreased from 10.4% in 1986-1995 to about 8% in 1996-2005 (P < 0.0001). Inflammatory radicular cysts are the most represented group among OCs in our area with a higher prevalence than that reported in other countries. The decreasing epidemiologic trend with time could be attributed to the possible changes in individual oral health behavior.

Retinol-binding protein 4 (RBP4) is an adipocytokine associated with insulin resistance (IR). We tested serum levels of RBP4 to assess its link with steatosis in patients with genotype 1 chronic hepatitis C (CHC) or nonalcoholic fatty liver disease (NAFLD). Nondiabetic patients with CHC (n = 143) or NAFLD (n = 37) were evaluated by liver biopsy and anthropometric and metabolic measurements, including IR by the homeostasis model assessment. Biopsies were scored by Scheuer classification for CHC, and Kleiner for NAFLD. Steatosis was tested as a continuous variable and graded as absent-mild or =30%. Thirty nondiabetic, nonobese blood donors served as controls. RBP4 levels were measured by a human competitive enzyme-linked immunosorbent assay kit (AdipoGen). Mean values of RBP4 were similar in NAFLD and CHC (35.3 +/- 9.3 microg/L versus 36.8 +/- 17.6; P = 0.47, respectively), and both were significantly higher than in controls (28.9 +/- 12.1; P = 0.02 and P = 0.01, respectively). RBP4 was higher in CHC patients with steatosis than in NAFLD (42.1 +/- 19.7 versus 35.2 +/- 9.3; P = 0.04). By linear regression, RBP4 was independently linked to steatosis only (P = 0.008) in CHC, and to elevated body mass index (P = 0.01) and low grading (P = 0.04) in NAFLD. By linear regression, steatosis was independently linked to homeostasis model assessment score (P = 0.03) and high RBP4 (P = 0.003) in CHC. By logistic regression, RBP4 was the only variable independently associated with moderate-severe steatosis in CHC (odds ratio, 1.045; 95% confidence interval, 1.020 to 1.070; P = 0.0004), whereas waist circumference was associated with moderate-severe steatosis in NAFLD (odds ratio, 1.095; 95% confidence interval, 1.007 to 1.192; P = 0.03). CONCLUSION: In nondiabetic, nonobese patients with genotype 1 CHC, serum RBP4 levels might be the expression of a virus-linked pathway to steatosis, largely unrelated to IR.

Multiple Sclerosis (MS) patients present a decrease of antioxidants and neuroprotective and immunoregulatory vitamins and an increase of total homocysteine (tHcy), cholesterol (CHL), HDL-cholesterol, and of cellular stress markers, variably associated with the different phases of the disease. We compared the blood levels of uric acid, folic acid, vitamins B12, A, and E, tHcy, CHL, HDL-cholesterol, and triglycerides in forty MS patients during a phase of clinical inactivity with those of eighty healthy controls, matched for age and sex. We found higher levels of tHcy (p = 0.032) and of HDL-cholesterol (p = 0.001) and lower levels of vitamin E (p = 0.001) and the ratio vitamin E/CHL (p = 0.001) in MS patients. In conclusion, modifications of some biochemical markers of cell damage were detected in MS patients during a phase of clinical inactivity.