Multi-year prevalence and macrolide resistance of Mycoplasma genitalium in clinical samples from a southern Italian hospital

The use of azithromycin for the treatment of Mycoplasma genitalium infections has led to resistance to macrolides. From July 2014 to July 2020, 7150 samples were analysed for the detection of sexually transmitted infections at the Policlinico of Bari. A total of 67/7150 samples (0.93%) were positive for MG DNA and 47 samples were analysed for the evaluation of six azithromycin resistance-associated mutations. In 5/47 samples, the A2058G mutation was detected (10.63%). Although the cases of positive MG samples and mutations are low in our reality, diagnostic tests to detect azithromycin resistant-associated genes may provide a convenient way to monitor resistance rate

Predictive value of hematological and phenotypical parameters on postchemotherapy leukocyte recovery

Background: Grade IV chemotherapy toxicity is defined as absolute neutrophil count <500/μL. The nadir is considered as the lowest neutrophil number following chemotherapy, and generally is not expected before the 7th day from the start of chemotherapy. The usual prophylactic dose of rHu-G-CSF (Filgrastim) is 300 μg/day, starting 24-48 h after chemotherapy until hematological recovery. However, individual patient response is largely variable, so that rHu-G-CSF doses can be different. The aim of this study was to verify if peripheral blood automated flow cytochemistry and flow cytometry analysis may be helpful in predicting the individual response and saving rHu-G-CSF. Methods: During Grade IV neutropenia, blood counts from 30 cancer patients were analyzed daily by ADVIA 120 automated flow cytochemistry analyzer and by Facscalibur flow cytometer till the nadir. "Large unstained cells" (LUCs), myeloperoxidase index (MPXI), blasts, and various cell subpopulations in the peripheral blood were studied. At nadir rHu-G-CSF was started and 81 chemotherapy cycles were analyzed. Cycles were stratified according to their number and to two dose-levels of rHuG-CSF needed to recovery (300-600 vs. 900-1200 μg) and analyzed in relation to mean values of MPXI and mean absolute number of LUCs in the nadir phase. The linear regressions of LUCs % over time in relation to two dose-levels of rHu-G-CSF and uni-multivariate analysis of lymphocyte subpopulations, CD34+ cells, MPXI, and blasts were also performed. Results: In the nadir phase, the increase of MPXI above the upper limit of normality (>10; median 27.7), characterized a slow hematological recovery. MPXI levels were directly related to the cycle number and inversely related to the absolute number of LUCs and CD34 +/CD45+ cells. A faster hematological recovery was associated with a higher LUC increase per day (0.56% vs. 0.25%), higher blast (median 36.7/μL vs. 19.5/μL) and CD34+/CD45+ cell (median 2.2/μL vs. 0.82/μL) counts. Conclusions: Our study showed that some biological indicators such as MPXI, LUCs, blasts, and CD34 +/CD45+ cells may be of clinical relevance in predicting individual hematological response to rHu-G-CSF. Special attention should be paid when nadir MPXI exceeds the upper limit of normality because the hematological recovery may be delayed. © 2009 Clinical Cytometry Society

Impact on Renal Function and Hospital Outcomes of an Individualized Management of Cardiopulmonary Bypass in Congenital Heart Surgery: A Pilot Study

During cardiopulmonary bypass (CPB), high flows can allow an adequate perfusion to kidneys, but, on the other hand, they could cause emboli production, increased vascular pressure, and a more intense inflammatory response, which are in turn causes of renal damage. Along with demographic variables, other intra-operative management and post-operative events, this might lead to Acute kidney injury (AKI) in infants undergoing cardiac surgery. The aim of our study was to investigate if a CPB strategy with flow requirements based on monitoring of continuous metabolic and hemodynamic parameters could have an impact on outcomes, with a focus on renal damage. Thirty-four consecutive infants and young children undergoing surgery requiring CPB, comparable as for demographic and patho-physiological profile, were included. In Group A, 16 patients underwent, for a variable period of 20 min, CPB aiming for the minimal flow that could maintain values of MVO2 > 70% and frontal NIRS (both left and right) > 45%, and renal NIRS > 65%. In Group B, 18 patients underwent nominal flows CPB. Tapered CPB allowed for a mean reduction of flows of 34%. No difference in terms of blood-gas analysis, spectroscopy trend, laboratory analyses, and hospital outcome were recorded. In patients developing AKI (20%), renal damage was correlated with demographic characteristics and with renal NIRS during the first 6 h in the ICU. A safe individualized strategy for conduction of CPB, which allows significant flow reduction while maintaining normal hemodynamic and metabolic parameters, does not impact on renal function and hospital outcomes

Valve Type and Operative Risks in Surgical Explantation of Transcatheter Aortic Valves: A Systematic Review and Meta-Analysis

Indication to perform surgical explantation of TAVR is becoming increasingly more frequent, due to the higher number of transcatheter procedures performed in patients with longer life expectancy. We proposed to perform a systematic review and meta-analysis with metaregression to identify potential factors that can determine an increase in the high mortality and morbidity that characterize these surgical procedures. MEDLINE and Embase were searched for relevant studies. Twelve studies were eligible according to our inclusion criteria. TAVR explantation was confirmed as a procedure with high 30-day mortality (0.17; 95% CI, 0.14–0.21) and morbidity (stroke incidence 5%; 95% CI, 0.04–0.07; kidney injury incidence 16%; 95% CI, 0.11–0.24). The type of transcatheter valve implanted during the index procedure did not influence the outcomes after surgical explantation. The role of these high-risk operations is growing, and it will likely expand in the coming years. Specific tools for risk stratification are required

Il controllo a distanza del datore di lavoro e il rispetto del diritto alla vita privata del lavoratore (ancora) sotto i riflettori della Corte Edu: il caso Gramaxo c. Portugal

The balance between the workers’ right to privacy and the employer’s legitimate interest in exercising remote control by means of Gps tracking was submitted to the European Court of Human Rights in the case Gramaxo c. Portugal. Taking into account the Court’s previous judicial decision as a starting point, this contribution will analyse the effects on domestic law of the rules on remote control and personal data protection, also with reference to geolocation data, with the aim of highlighting the changing nature of the limits imposed to the employers’ interests by the European Court of Human Rights.El equilibrio entre el derecho a la intimidad de los trabajadores y el interés legítimo del empleador en ejercer el control a distancia mediante el seguimiento por Gps se sometió al Tribunal Europeo de Derechos Humanos en el asunto Gramaxo c. Portugal. Teniendo en cuenta la anterior decisión judicial del Tribunal como punto de partida, esta contribución analizará los efectos en el derecho interno de las normas sobre control remoto y protección de datos personales, también con referencia a los datos de geolocalización, con el objetivo de destacar la naturaleza cambiante de los límites impuestos a los intereses del empleador por el Tribunal Europeo de Derechos Humanos.L'equilibrio tra il diritto alla privacy dei lavoratori e il legittimo interesse datoriale a esercitare il potere di controllo a distanza mediante la localizzazione Gps è stato sottoposto alla Corte europea dei diritti dell'uomo nel caso Gramaxo c. Portogallo. Partendo dai precedenti della Corte Edu, il presente contributo analizzerà gli effetti sul diritto interno delle norme sul controllo a distanza e sulla protezione dei dati personali, anche con riferimento ai dati di geolocalizzazione, con l'obiettivo di evidenziare la natura mutevole dei limiti imposti agli interessi dei datori di lavoro dalla Corte europea dei diritti dell'uomo

I Giudici di Pace al vaglio della Corte di Giustizia: diritto alle ferie retribuite o apertura verso la subordinazione?

La nota analizza la pronuncia della Corte di Giustizia Europea del 16 luglio 2020, C-658/2018 la quale si inserisce in un filone giurisprudenziale teso ad indagare, in generale, la effettiva natura del rapporto di servizio intercorrente tra cariche onorarie e Ministero della Giustizia, con lo scopo di rintracciare elementi tipici della subordinazione che potrebbero far protendere verso una riqualificazione del rapporto stesso, nonché, in particolare, l'estensione del diritto alle ferie retribuite anche per i Giudici di Pace