Isolated laryngeal leishmaniasis in immunocompetent patients: an underdiagnosed disease.

We describe a case of isolated primary laryngeal leishmaniasis in an immunocompetent Italian patient with a previous medical history negative for visceral or cutaneous leishmaniasis, presenting with hoarseness. We also summarize the epidemiological, clinical, and diagnostic features and the therapeutic management of other cases of laryngeal leishmaniasis in immunocompetent subjects, described in the literature. Considering the insidious and nonspecific clinical presentation, the increasing number of different forms of mild or underestimated immunosuppressive conditions, and the number of people travelling in endemic zones, along with the ability of Leishmania amastigotes to survive for a long period in the body, we believe it is important for pathologists and clinicians to be aware of this unusual form of leishmaniasis in order to avoid delayed recognition and treatment. The rarity of the presentation and the lack of guidelines on mucosal leishmaniasis may contribute to the potential undiagnosed cases or delayed diagnosis, the possible relapses, as well as the correct pharmacological and/or surgical therapeutic approach

Lung ultrasound may support internal medicine physicians in predicting the diagnosis, bacterial etiology and favorable outcome of community-acquired pneumonia

To assess the usefulness of lung ultrasound (LUS) for identifying community-acquired pneumonia (CAP) among adult patients with suspected lower respiratory tract infection (LRTI) and for discriminating between CAP with different cultural statuses, etiologies, and outcomes. LUS was performed at internal medicine ward admission. The performance of chest X-ray (CXR) and LUS in diagnosing CAP in 410 patients with suspected LRTI was determined. All possible positive results for pneumonia on LUS were condensed into pattern 1 (consolidation + / - alveolar-interstitial syndrome) and pattern 2 (alveolar-interstitial syndrome). The performance of LUS in predicting culture-positive status, bacterial etiology, and adverse outcomes of CAP was assessed in 315 patients. The area under the receiver operating characteristic curve for diagnosing CAP by LUS was significantly higher than for diagnosis CAP by CXR (0.93 and 0.71, respectively; p < 0.001). Pattern 1 predicted CAP with bacterial and mixed bacterial and viral etiologies with positive predictive values of 99% (95% CI, 94-100%) and 97% (95% CI, 81-99%), respectively. Pattern 2 ruled out mortality with a negative predictive value of 95% (95% CI, 86-98%), respectively. In this study, LUS was useful in predicting a diagnosis of CAP, the bacterial etiology of CAP, and favorable outcome in patients with CAP

"Diagnosis on the Dock" project: A proactive screening program for diagnosing pulmonary tuberculosis in disembarking refugees and new SEI model.

Abstract Objective From 2011 to 2017, the total number of refugees arriving in Europe, particularly in Italy, climbed dramatically. Our aim was to diagnose pulmonary TB in migrants coming from the African coast using a clinical-based port of arrival (PoA) screening program. Methods From 2016 to 2018, migrants coming via the Mediterranean Route were screened for body temperature and the presence of cough directly on the dock: if they were feverish with productive cough, their sputum was examined with NAAT; with a dry cough, they underwent Chest-X-ray (CXR). Those migrants with positive NAAT or CXR suggestive for TB were admitted to our ward. In addition, we plotted an SEI simulation of our project to evaluate the epidemiological impact of our screening. Results Out of 33.676 disembarking migrants, 314 (0.9%) had fever and cough: 80 (25.47%) with productive cough underwent NAAT in sputum, and 16 were positive for TB; 234 (74.52%) with dry cough had a CXR examination, and 39 were suggestive of TB, later confirmed by mycobacterial culture. The SEI-new model analysis demonstrated that our screening program significantly reduced TB spreading all over the country. Conclusions For possible future high migrant flows, PoA screening for TB has to be considered feasible and effective in decreasing TB spreading

Prolonged higher dose methylprednisolone vs. conventional dexamethasone in COVID-19 pneumonia: a randomised controlled trial (MEDEAS)

Dysregulated systemic inflammation is the primary driver of mortality in severe COVID-19 pneumonia. Current guidelines favor a 7-10-day course of any glucocorticoid equivalent to dexamethasone 6 mg·day-1. A comparative RCT with a higher dose and a longer duration of intervention was lacking

Shape measurements of volcanic particles by CAMSIZER

The shape of volcanic particles is an important parameter holding information related to physical and geochemical processes. The study of particle shape may help improving knowledge on the main eruptive processes (fragmentation, transport and sedimentation) during explosive activity. In general, volcanic ash is formed by different components, namely juvenile, lithic and crystal particles, each one characterized by peculiar morphology. Moreover, quantifying the shape of pyroclasts is needed by the most recent dispersal models that consider shape parameters as input data to simulate tephra dispersal. However, measuring and quantifying the particle shape of volcanic particles are hard challenges especially when the number of the particles to investigate is high and the size small (e.g. sub-millimetric). Several methods are currently used in volcanology, the most common probably being quantitative shape analysis by Scanning Electron Microscopy (SEM), based on the acquisition and subsequent analysis of digital images. Here, we describe a new methodology to measure the shape of volcanic particles by CAMSIZER®, a compact laboratory instrument developed by Retsch Technology (see http://www.retsch.com) for the simultaneous measurement of particle size distribution and particle shape of incoherent materials in the range of 30 µm to 30 mm, based on digital image processing. The sample is fed in from a vibrating feed channel that controls particles falling through the measurement field, where images of the particle are recorded by two digital cameras (Basic and Zoom) with different resolutions. Software, created by Retsch Technology, enables digital image processing to provide grain-size and shape parameters. This instrument, very common for quality control in industry, research and production monitoring of very different kinds of materials, has been installed at Istituto Nazionale di Geofisica e Vulcanologia, Sezione di Catania (INGV-CT) to measure and validate grain-size distribution of volcanic particles (Lo Castro and Andronico, 2008; 2009). Recently, we made a new study to assess its use in analysing the shape of volcanic particles. Size and shape of particles are calculated by applying a number of mathematical models related to different geometric parameters that influence the final results. Measures of shape parameters (e.g. Feret diameter, roundness, symmetry, width, length) are performed under a high resolution scanning of each particle in 64 different directions. In order to study volcanic particle shape characteristics, we performed different tests on volcanic and non-volcanic materials, considering the most commonly used shape parameters. Finally, we compared and validated the obtained results with those carried out by binocular microscope image analysis on the same samples. Furthermore, on the basis of these measurements, a clustering analysis is proposed. In particular, the Self Organized Map (SOM) and the K-means algorithm have been used jointly in order to partition a generic sample of volcanic ash particles into subsets sharing some common shape features. A fuzzy c-mean analysis has also been used to verify and compare results. These analyses were aimed at developing an automatic shape clustering of the volcanic ash particles. Preliminary results of both image analysis and statistical testing are shown to understand if CAMSIZER is a suitable tool for quantifying and characterizing volcanic particle shapes.PublishedRimini2.3. TTC - Laboratori di chimica e fisica delle rocceope

Skeletal Muscle in Hypoxia and Inflammation: Insights on the COVID-19 Pandemic

SARS-CoV-2 infection is often associated with severe inflammation, oxidative stress, hypoxia and impaired physical activity. These factors all together contribute to muscle wasting and fatigue. In addition, there is evidence of a direct SARS-CoV-2 viral infiltration into skeletal muscle. Aging is often characterized by sarcopenia or sarcopenic obesity These conditions are risk factors for severe acute COVID-19 and long-COVID-19 syndrome. From these observations we may predict a strong association between COVID-19 and decreased muscle mass and functions. While the relationship between physical inactivity, chronic inflammation, oxidative stress and muscle dysfunction is well-known, the effects on muscle mass of COVID-19-related hypoxemia are inadequately investigated. The aim of this review is to highlight metabolic, immunity-related and redox biomarkers potentially affected by reduced oxygen availability and/or muscle fatigue in order to shed light on the negative impact of COVID-19 on muscle mass and function. Possible countermeasures are also reviewed

Mucosal Leishmaniasis: An Underestimated Presentation of a Neglected Disease

We present a review of current knowledge about mucosal leishmaniasis (ML). Although involvement of mucous membranes is classically admitted in New World leishmaniasis, particularly occurring in infection by Leishmania (L.) braziliensis species complex, ML is also a possible presentation of Old World leishmaniasis, in either L. donovani or L. major species complex infections. Thus, ML has to be considered not only as a Latin American disease but as an Old and New World disease. We describe ML epidemiology, pathogenesis, clinics, diagnosis, and therapy. Considering both its highly disfiguring lesions and its possible lethal outcome, ML should not be underestimated by physicians. Moreover, leishmaniasis is expected to increase its burden in many countries as sandfly vector distribution is widespreading towards non-endemic areas. Finally, the lack of clear understanding of ML pathogenesis and the absence of effective human vaccines strongly claim for more research

Carbon nanotubes and central nervous system: Environmental risks, toxicological aspects and future perspectives

Due to their morphological and physicochemical properties, carbon nanotubes (CNTs) enhance the structural properties of several materials and are produced in great volumes. The production and the manufacturing of CNTs-incorporated products can lead to the potential environmental release of CNTs. For these reasons, CNTs can represent a serious concern for human health. Humans are exposed to nanoparticles through inhalation, ingestion and skin uptake. After their entrance, the particles can reach the Central Nervous System (CNS) through three different pathways: the systemic, olfactory and trigeminal pathways. In the first, through systemic blood circulation, nanoparticles cross both the blood-brain and blood-spinal cord barriers, which are highly selective semipermeable barriers that protect the CNS compartments. The second is the step from the nose to brain route and occurs along axons and via nerve bundles that cross the cribriform plate to the olfactory bulb. In the third, the compounds diffuse through the nasal cavity mucosa to reach the branches of the trigeminal nerve in the olfactory and respiratory regions, and they reach brain stem via axonal transport. After their entrance, CNTs reach the CNS where they may cause cytotoxicity of selected neurons in several CNS regions, impairing molecular pathways and contributing to the onset and progression of chronic brain inflammation, microglia activation and white matter abnormalities with an increased risk for autism spectrum disorders, lower IQ in children, neurodegenerative diseases and stroke. The large surface area to mass ratio of CNTs greatly increases surface reactivity. Despite this property considerable contributes to their toxicological pro\ufb01le in biological systems, also makes CNTs very attractive in the medical field, where they can be used as carriers of bioactive molecules, contrast agents, biological platforms and for many other applications in medicine

Early lean mass sparing effect of high-protein diet with excess leucine during long-term bed rest in women

Muscle inactivity leads to muscle atrophy. Leucine is known to inhibit protein degradation and to promote protein synthesis in skeletal muscle. We tested the ability of a high-protein diet enriched with branched-chain amino acids (BCAAs) to prevent muscle atrophy during long-term bed rest (BR). We determined body composition (using dual energy x-ray absorptiometry) at baseline and every 2-weeks during 60 days of BR in 16 healthy young women. Nitrogen (N) balance was assessed daily as the difference between N intake and N urinary excretion. The subjects were randomized into two groups: one received a conventional diet (1.1 +/- 0.03 g protein/kg, 4.9 +/- 0.3 g leucine per day) and the other a high protein, BCAA-enriched regimen (1.6 +/- 0.03 g protein-amino acid/kg, 11.4 +/- 0.6 g leucine per day). There were significant BR and BR x diet interaction effects on changes in lean body mass (LBM) and N balance throughout the experimental period (repeated measures ANCOVA). During the first 15 days of BR, lean mass decreased by 4.1 +/- 0.9 and 2.4 +/- 2.1% (p < 0.05) in the conventional and high protein-BCAA diet groups, respectively, while at the end of the 60-day BR, LBM decreased similarly in the two groups by 7.4 +/- 0.7 and 6.8 +/- 2.4%. During the first 15 days of BR, mean N balance was 2.5 times greater (p < 0.05) in subjects on the high protein-BCAA diet than in those on the conventional diet, while we did not find significant differences during the following time intervals. In conclusion, during 60 days of BR in females, a high protein-BCAA diet was associated with an early protein-LBM sparing effect, which ceased in the medium and long term

Pulmonary Kaposi Sarcoma without Respiratory Symptoms and Skin Lesions in an HIV-Naïve Patient: A Case Report and Literature Review

Kaposi sarcoma (KS) is a multifocal lympho-angioproliferative, mesenchymal low-grade tumor associated with a γ2-herpesvirus, named Kaposi sarcoma-associated virus or human herpesvirus (KSHV/HHV8). The lung is considered a usual anatomical location of KS, despite being infrequent, often in association with extensive mucocutaneous lesions and very uncommonly as an isolated event. We report a case of a pulmonary KS (pKS) in a human immunodeficiency virus (HIV) naïve patient, which was atypical due to a lack of cutaneous involvement and an absence of respiratory symptoms. The pKS was initially identified as a tumoral suspected nodular lesion and only after immunohistochemical analysis was it characterized as KS. Furthermore, the diagnosis of pKS led to the discovery of the HIV-seropositive status of the patient, previously unknown. Our report underlines the importance of considering pKS even without skin lesions and as a first manifestation of HIV infection. We also reviewed literature on the current knowledge about pKS in people living with HIV (PLWH) to underline how one of the most common HIV/acquired immunodeficiency syndrome (AIDS) associated tumors can have a challenging localization and be difficult to recognize