Standard di professione del dietista in nefrologia: realtà a confronto

La terapia dietetica svolge un ruolo fondamentale nel trattamento della malattia renale cronica (CKD): previene e corregge le complicanze metaboliche, garantisce il mantenimento o il raggiungimento di uno stato nutrizionale soddisfacente e, nella fase conservativa, ritarda l'inizio della terapia sostitutiva. Molte sono le evidenze che attestano che il trattamento nutrizionale effettuato da un dietista esperto migliora la qualità di vita del paziente con insufficienza renale cronica, aumenta l'eff -cacia della terapia dietetica e riduce i costi assistenziali. Negli Stati Uniti sono stati definiti i parametri che identificano il dietista esperto nella gestione della terapia nutrizionale nel paziente nefropatico e sono state individuate tre categorie in base al grado di formazione e competenza acquisita. Nei Paesi dell'Unione Europea la formazione dei dietisti è molto eterogenea tanto da rendere difficile una comparazione con la realtà americana. L'European Federation of the Association of Dietitians negli ultimi anni ha comunque definito gli standard accademici e professionali dei dietisti individuando quattro ruoli di competenza ed i relativi indicatori di performance. In Italia l'Associazione Nazionale Dietisti ha definito le posizioni dell'associazione in merito alla pratica professionale del dietista nel trattamento delle malattie renali e la Società Italiana di Nefrologia, nell'ambito del progetto di certificazione della qualità del percorso di cura della CKD, ha delineato il profilo del dietista che lavora in nefrologia ma non sono stati definiti standard accademici e professionali specifici. È auspicabile che dietisti esperti in nefrologia e nefrologi collaborino nel definire protocolli relativi a standard che il dietista operante in ambito nefrologico dovrebbe raggiungere in modo da garantire maggiore competenza professionale e una omogeneità di trattamento su tutto il territorio nazionale

Influence of rainfall on E. coli concentrations in clams: results of collaboration between competent health authority and producers’ association in the Province of Fermo (Italy)

The Area Vasta di Fermo (the competent health authority of the Marche Region), in collaboration with the local Producers’ Association conducted a series of studies on the presence of E. coli as an indicator of faecal contamination in the environment, in shellfish and in fishery waters, and on the factors that can affect their presence. These studies, carried out from 2008 to 2011, included an assessment of the currents along the coast, of the precipitations, and data from the monitoring of E. coli on shellfish harvested in the collection areas were examined. The results showed that in most cases, small concentrations of microorganisms in shellfish corresponded to little or no precipitations, while an increase in the levels of E. coli was preceded by more or less abundant rainfalls. The conclusions suggest that it is advisable to carry out a more detailed risk analysis which should take into account the above-mentioned factors. Furthermore, monitoring alone based on the determination of indicator organisms, especially when carried out as a single analysis or with a small number of E. coli determinations, does not provide a satisfactory indication of safety. The regional surveillance plans should be applied timely and rigorously, together with on-site investigations aimed at identifying changes that can affect the presence of E. coli in shellfish. Food business operators themselves could implement good manufacturing practices to verify whether the microbiological parameters are within the prescribed limits after rainfalls, especially if heavy

PRESENCE OF TRICHINELLA BRITOVI IN WILD BOAR IN THE MARCHE REGION REGULARLY SLAUGHTERED

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Novel splice-affecting variants in CYP27A1 gene in two Chilean patients with Cerebrotendinous Xanthomatosis

Cerebrotendinous Xanthomatosis (CTX), a rare lipid storage disorder, is caused by recessive loss-of-function mutations of the 27-sterol hydroxylase (CYP27A1), producing an alteration of the synthesis of bile acids, with an accumulation of cholestanol. Clinical characteristics include juvenile cataracts, diarrhea, tendon xanthomas, cognitive impairment and other neurological manifestations. Early diagnosis is critical, because treatment with chenodeoxycholic acid may prevent neurological damage. We studied the CYP27A1 gene in two Chilean CTX patients by sequencing its nine exons, exon-intron boundaries, and cDNA from peripheral blood mononuclear cells. Patient 1 is a compound heterozygote for the novel substitution c.256-1G > T that causes exon 2 skipping, leading to a premature stop codon in exon 3, and for the previously-known pathogenic mutation c.1183C > T (p.Arg395Cys). Patient 2 is homozygous for the novel mutation c.1185-1G > A that causes exon 7 skipping and the generation of a premature stop codon in exon 8, leading to the loss of the crucial adrenoxin binding domain of CYP27A1

MICROBIOLOGICAL MONITORING PLAN OF VENUS GALLINA PRODUCTION ZONES: THE EXPERIENCE OF Z.T. 11 OF FERMO IN THE PERIOD 2009/2010

Shellfish may pose a risk in food safety, which is why the monitoring of the waters must be classified before the collection of live bivalve molluscs. These animals are filter feeders that accumulate microorganisms and chemicals present in water. Regulation (EC) 854/04 provides that Member States ensure the classification of production areas of bivalve molluscs and establish a surveillance system on the areas of classification and the production facilities that allows continuous monitoring of the healthiness of these products and health quality of water. This paper reports the results of the microbiological production areas of Venus gallina pertaining to the Z.T. 11 Fermo for the years 2009-2010. From our experience, it is the important to have an adequate monitoring regional system and the involvement of professionals in this sector for an effective prevention. So it is of great importance to involve all the different workers in this field

Study on the possibility to use the allochthonous bivalve mollusc Scapharca inaequivalvis (Bruguire) in the human alimentation.

A research was carried out in order to investigate from a chemical point of view about the possibility to use the Asiatic mollusc Scapharca inaequivalvis in the human alimentation. The chemical composition and the acidic profile were determined on a pool of samples collected aloang the coast of Marche region. The results showed a situation similar to that obtained on other bivalve molluscs

Association of genetic variation in adaptor protein APPL1/APPL2 loci with non-alcoholic fatty liver disease

The importance of genetics and epigenetic changes in the pathogenesis of non alcoholic fatty liver disease (NAFLD) has been increasingly recognized. Adiponectin has a central role in regulating glucose and lipid metabolism and controlling inflammation in insulin-sensitive tissues and low adiponectin levels have been linked to NAFLD. APPL1 and APPL2 are adaptor proteins that interact with the intracellular region of adiponectin receptors and mediate adiponectin signaling and its effects on metabolism. The aim of our study was the evaluation of a potential association between variants at APPL1 and APPL2 loci and NAFLD occurrence. The impact on liver damage and hepatic steatosis severity has been also evaluated. To this aim allele frequency and genotype distribution of APPL1-rs3806622 and -rs4640525 and APPL2-rs 11112412 variants were evaluated in 223 subjects with clinical diagnosis of NAFLD and compared with 231 healthy subjects. The impact of APPL1 and APPL2 SNPs on liver damage and hepatic steatosis severity has been also evaluated. The minor-allele combination APPL1-C/APPL2-A was associated with an increased risk of NAFLD (OR = 2.50 95% CI 1.45-4.32; p < 0.001) even after adjustment for age, sex, body mass index, insulin resistance (HOMA-IR), triglycerides and adiponectin levels. This allele combination carrier had higher plasma alanine aminotransferase levels (Diff = 15.08 [7.60-22.57] p = 0.001) and an increased frequency of severe steatosis compared to the reference allele combination (OR = 3.88; 95% CI 1.582-9.531; p < 0.001). In conclusion, C-APPL1/A-APPL2 allele combination is associated with NAFLD occurrence, with a more severe hepatic steatosis grade and with a reduced adiponectin cytoprotective effect on liver