Prevention of fecal-orally transmitted diseases in travelers through an oral anticholeric vaccine (WC/rBS)

Introduction. Estimate the efficacy of oral anticholeric vaccine Dukoral® in subjects travelling to high-risk areas for traveler?s diarrhoea and cholera. Methods. The study involved subjects of both genders who planned to travel to high-risk areas for traveler?s diarrhoea and cholera. Immunization with oral anticholeric vaccine Dukoral® was offered to each one of them. Upon returning, all the participants in the study were asked to complete a self-administered questionnaire consisting of 40 close-ended questions mainly concerning: personal and health data, characteristics (length, destination, reason) of the travel, onset of gastrointestinal symptoms, data relating to the assumption of anti- choleric vaccine and possible adverse reactions. Results. 296 questionnaires have been collected. Mean age was 38.2 years (55.4% males and 44.6% females). Mean travel length was 22.2 days. Reasons for the travel: 66.8% tourism and 33.2% work-cooperation. Most frequent destination was Africa (48.1%), followed by Asia (32.1%) and Central South- America (17.8%). 199 subjects (67.2%) properly executed vac- cination with Dukoral®. The diarrhoea affected 14.1% of vacci- nated subjects and 20.6% of non vaccinated ones. The following cohorts showed statistically significant differences in incidence of diarrhoea: inf. 35 years old age (13.7% vs. 27.1%), travel for work-cooperation (14.1% vs. 35%) and travel length > 28 days (12.1% vs. 40%). No serious adverse events were reported fol- lowing vaccination. Discussion. Oral Anticholeric vaccine proved to be effective and safe in preventing fecal-oral diseases in travelers exposed to high risk conditions

Presence of Legionella spp. in human dental plaque

Aims. The aim of this research is to verify the presence of Legionella in human dental plaque. Methods. 65 adult patients not treated with systemic or local antibiotics at least 2 months before the time of sample collection were enrolled for plaque collection between September 2015 and December 2016. A brief questionnaire about lifestyle and health risks was administered. Legionella spp. detection has been executed by semi- nested PCR. Results. 8 out of 65 plaque samples (12.3%) were positive for Legionella spp. As regards health risks and lifestyle aspects, no relevant difference was observed between patients involved in our study, except for two positive patients who have reported a COPD ongoing and a pneumonia in the past. Conclusions. This study represents a step forward in the knowledge of reservoirs of the microorganism and richness of oral microbiot

Valutazione dell\u2019impatto economico delle infezioni ospedaliere in Lombardia: risultati di uno studio in 88 ospedali

Objectives: To assess the consumption levels of proton pump inhibitors (PPIs) in Italy, in comparison with some foreign markets. To investigate the practice in PPI prescribing in Italy, in comparison with consumption standards. Design: The DDD (Defined Daily Dose) tool was adopted as the best unit of measure to be used in fulfilling the first objective. With regard to the second objective, in order to estimate the PDDs (Prescribed Daily Doses) in the PPI area, a large sample (8940 prescription episodes) was drawn from the Health Search database, a facility created by Societ\ue0 Italiana di Medicina Generale and supported by a number of pharmaceutical companies. Results: The Italian PPI market size was 198.2 million DDDs in 2000 (more than twice the 1995 data), corresponding to 9.4 DDDs per 1000 people per day (that is, about 1% of the Italian population is treated every day with PPIs). In the same year, PPI consumption was 16.5 DDDs per 1000 people per day in France and 19.3 in the UK. In Italy, the ratio between PPI and H2-antagonists consumption (1.6) was lowest, as compared with France (4.5) and with UK (1.8). With regard to omeprazole, the prescription practice (weighted average PDD: 25.4 mg) was higher than its standard (DDD: 20 mg); similar results were found for pantoprazole (46 vs 40 mg) and rabeprazole (22.2 vs 20 mg). On the contrary, lansoprazole's PDD (23.4 mg) was lower than its DDD (30 mg); however, the average length of therapy with lansoprazole turned out to be longer. Conclusions: The PPI market is expanding in Italy, although to a lesser extent and with more competition from H2-antagonists as compared with France and the UK. When evaluating prescription practices and their costs, the DDD tool has clear limitations, while PDD is a better measure. However, not only PDD amounts but also lengths of therapies should be taken into consideration in order to formulate sound judgements about treatment costs

Aetiology and prognosis of bacteraemia in Italy

A prospective multi-centre study was conducted to assess the microbiological pattern and prognostic factors of bacteraemia and their impact on clinical outcome. All patients admitted to 41 Italian hospitals over 2 months, from whom one or more clinically significant organisms were isolated from blood culture, were studied according to a standardized protocol and case definition. A total of 156 episodes of bacteraemia were identified in 20 601 patients. There were 3.9 episodes of nosocomially acquired bacteraemia and 3.7 episodes of community-acquired bacteraemia per 1000 admissions. The most frequent pathogens isolated were Gram-negative bacteria (44.9%) but Gram-positive species accounted for 40.4% of episodes. Fungal infections due to Candida spp. were found in 3.8% of episodes, and multiple pathogens were recovered from 9.6% of episodes. The clinical response to bacteraemia was classified as sepsis in 90 episodes (57.7%), severe sepsis in 21 (13.5%) and septic shock in 26 (16.7%) ; 19 episodes (12.2%) showed no clinical response. The total in-hospital mortality was 25.0%. By multivariate logistic regression, the variables which independently predicted mortality were increasing age, the presence of septic shock, infection with Gram-positive bacteria or fungi and nosocomial acquisition

Epidemiologia dell’infezione da HIV e suo sistema informativo.

Proposta di manuale di qualità per la prevenzione dell’infezione da HIV per l’assistenza domiciliare e le Case alloggi

Impact of respiratory tract infections of heptavalent pneumococcal conjugate vaccine administered at 3, 5 and 11 months of age

Background: Medical and public health importance of pneumococcal infections justifies the implementation of measures capable of reducing their incidence and severity, and explains why the recently marketed heptavalent pneumococcal conjugate vaccine (PCV-7) has been widely studied by pediatricians. This study was designed to evaluate the impact of PCV-7 administered at 3, 5 and 11 months of age on respiratory tract infections in very young children.Methods: A total of 1,571 healthy infants (910 males) aged 75-105 days (median 82 days) were enrolled in this prospective cohort trial to receive a hexavalent vaccine (DTaP/IPV/HBV/Hib) and PCV-7 (n = 819) or the hexavalent vaccine alone (n = 752) at 3, 5 and 11 months of age. Morbidity was recorded for the 24 months following the second dose by monthly telephone interviews conducted by investigators blinded to the study treatment assignment using standardised questionnaires. During these interviews, the caregivers and the children's pediatricians were questioned about illnesses and the use of antibiotics since the previous telephone call. All of the data were analysed using SAS Windows v.12.Results: Among the 1,555 subjects (98.9%) who completed the study, analysis of the data by the periods of follow-up demonstrated that radiologically confirmed community-acquired pneumonia (CAP) was significantly less frequent in the PCV-7 group during the follow-up as a whole and during the last period of follow-up. Moreover, there were statistically significant between-group differences in the incidence of acute otitis media (AOM) in each half-year period of follow-up except the first, with significantly lower number of episodes in children receiving PCV-7 than in controls. Furthermore, the antibiotic prescription data showed that the probability of receiving an antibiotic course was significantly lower in the PCV-7 group than in the control group.Conclusion: Our findings show the effectiveness of the simplified PCV-7 schedule (three doses administered at 3, 5 and 11-12 months of age) in the prevention of CAP and AOM, diseases in which Streptococcus pneumoniae plays a major etiological role. A further benefit is that the use of PCV-7 reduces the number of antibiotic prescriptions. All of these advantages may also be important from an economic point of view