Accident Triggered by Electrical Failures in Seveso Sites

Electrical maintenance is important for appropriate of Major Accident Prevention Policy MAPP at Seveso sites. At Seveso sites, many accidents include in the causes an electrical failure, due usually to a poor maintenance. Power outages, in particular, originate cascade effects, leading to a possible loss of hazardous materials. The repository of the minor incidents and near misses recorded at Seveso sites is a valuable source for investigating electrical failures, causes, effects and possible prevention and mitigation measures. The present paper discusses a number of incident records, gathered at Seveso establishments, during the mandatory inspections, required by the Seveso Directive. Gathered documents cover different types of plant, including refineries, oil terminal, LPG depots and chemical plants. They have been analysed, using advanced method, including machine learning. The results of this analysis have been exploited to provide the establishments’ operator with a few recommendations, essential to improve electrical safety and prevent major accidents

Clinical and therapeutic aspects of candidemia: A five year single centre study

B ackground Candida is an important cause of bloodstream infections (BSI) in nosocomial settings causing significant mortality and morbidity. This study was performed to evaluate contemporary epidemiology, species distribution, antifungal susceptibility and outcome of candida BSI in an Italian hospital. Methods All consecutive patients who developed candidemia at Santa Maria della Misericordia University Hospital (Italy) between January 2009 and June 2014 were enrolled in the study. Results A total of 204 episodes of candidemia were identified during the study period with an incidence of 0.79 episodes/1000 admissions. C. albicans was isolated in 60.3% of cases, followed by C. parapsilosis (16.7%), C. glabrata (11.8%) and C. tropicalis (6.4%). Of all Candida BSI, 124 (60.8 %) occurred in patients admitted to IMW, 31/204 (15.2 %) in ICUs, 33/204 (16.2%) in surgical units and 16/204 (7.8%) in Hematology/Oncology wards. Overall, 47% of patients died within 30 days from the onset of candidemia. C. parapsilosis and C. glabrata candidemia were associated with the lowest mortality rate (36%), while patients with C. tropicalis BSI had the highest mortality rate (58.3%). Lower mortality rates were detected in patients receiving therapy within 48 hours from the time of execution of the blood cultures (57,1% vs 38,9%, P <0.05). At multivariate analysis, steroids treatment (OR= 0.27, p=0.005) and CVC removal (OR=3.77, p=0.014) were independently associated with lower and higher survival probability, respectively. Candidemia in patients with peripherally inserted central catheters (PICC) showed to be associated with higher mortality in comparison with central venous catheters (CVC, Short catheters and Portacath) and no CVC use. For each point increase of APACHE III score, survival probability decreased of 2%. Caspofungin (OR=3.45, p=0.015) and Amphothericin B lipid formulation (OR=15.26, p=0.033) were independently associated with higher survival probability compared with no treatment

Impatto della pertosse nella popolazione e strategie di prevenzione vaccinale

L'impatto epidemiologico della pertosse ha subito variazioni rilevanti soprattutto in et\ue0 pedia-trica, in seguito alla disponibilit\ue0 di vaccini cellulari altamente efficaci e alla successiva dif-fusione di preparati acellulari, caratterizzati da un migliore profilo di tollerabilit\ue0 e formulati in combinazione con altre componenti antigeniche. Cionondimeno, la pertosse rappresenta tutt\u2019oggi un\u2019importante causa di morbosit\ue0 e mortalit\ue0 nei neonati non ancora vaccinati o che non hanno completato il ciclo primario, e che possono essere infettati dai contatti suscettibili. Le coperture vaccinali sub-ottimali, la progressiva riduzione della protezione immunitaria conferita sia dall\u2019infezione naturale sia dalla vaccinazione e la mancata effettuazione dei richiami vaccinali contribuiscono, infatti, a rendere gli adolescenti e gli adulti le fonti princi-pali di trasmissione dell'infezione ai neonati. Strategie di prevenzione integrate e indirizzate a tutti i target coinvolti nella trasmissione dell'infezione (i.e. soggetti in et\ue0 pediatrica, ado-lescente e adulta, le donne in gravidanza, e gli operatori sanitari) rappresentano, pertanto, uno strumento chiave per il controllo della pertosse

Is first-line antimicrobial therapy still adequate to treat MRSA in the ICU? A report from a highly endemic country

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Genotyping of circulating measles strains in Italy in 2010

Introduction. The European Regional Office of the World Health Organization developed a strategic approach to stop the indigenous transmission of measles in its 53 Member States by 2015. In Italy, laboratory surveillance activity is implemented by the National Reference Laboratory for Measles and Rubella at the Italian National Institute of Health (Istituto Superiore di Sanità, Rome). The role of the National Reference Laboratory is to strengthen surveillance systems through rigorous case investigation and laboratory confirmation of suspected sporadic cases and outbreaks. Genetic characterization of wild-type measles virus is an essential component of the laboratory-based surveillance. This study describes the molecular characterization of measles virus strains isolated during 2010. Methods. Dried blood spots, urine and oral fluid samples were collected from patients with a suspected measles infection. Serological tests were performed on capillary blood, and viral detection was performed on urine and oral fluid samples through molecular assay. Positive samples were sequenced and phylogenetically analysed.Results and discussion. The phylogenetic analysis showed a co-circulation of genotypes D4 and D8, and sporadic cases associated to genotypes D9 and B3. Then, molecular epidemiology of measles cases permitted to establish that D4 and D8 were the endemic genotypes in Italy during 2010

A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality

Abstract Purpose: Clinical data on patients with intra-abdominal candidiasis (IAC) is still scarce. Methods: We collected data from 13 hospitals in Italy, Spain, Brazil, and Greece over a 3-year period (2011\u20132013) including patients from ICU, medical, and surgical wards. Results: A total of 481 patients were included in the study. Of these, 27 % were hospitalized in ICU. Mean age was 63 years and 57 % of patients were male. IAC mainly consisted of secondary peritonitis (41 %) and abdominal abscesses (30 %); 68 (14 %) cases were also candidemic and 331 (69 %) hadconcomitant bacterial infections. The most commonly isolated Candida species were C. albicans (n = 308 isolates, 64 %) and C. glabrata (n = 76, 16 %). Antifungal treatment included echinocandins (64 %), azoles (32 %), and amphotericin B (4 %). Septic shock was documented in 40.5 % of patients. Overall 30-day hospital mortality was 27 % with 38.9 % mortality in ICU. Multivariate logistic regression showed that age (OR 1.05, 95 % CI 1.03\u20131.07, P\0.001), increments in 1-point APACHE II scores (OR 1.05, 95 % CI 1.01\u20131.08, P = 0.028), secondary peritonitis (OR 1.72, 95 % CI 1.02\u20132.89, P = 0.019), septic shock (OR 3.29, 95 % CI 1.88\u20135.86, P\0.001), and absence of adequate abdominal source control (OR 3.35, 95 % CI 2.01\u20135.63, P\0.001) wereassociated with mortality. In patients with septic shock, absence of source control correlated with mortality rates above 60 % irrespective of administration of an adequate antifungal therapy. Conclusions: Low percentages of concomitant candidemia and high mortality rates are documented in IAC. In patients presenting with septic shock, source control is fundamental

Plants and traditional knowledge: An ethnobotanical investigation on Monte Ortobene (Nuoro, Sardinia)

<p>Abstract</p> <p>Background</p> <p>Most of the traditional knowledge about plants and their uses is fast disappearing as a consequence of socio-economic and land use changes. This trend is also occurring in areas that are historically exposed to very few external influences, such as Sardinia (Italy). From 2004 to 2005, an ethnobotanical investigation was carried out in the area of Monte Ortobene, a mountain located near Nuoro, in central Sardinia.</p> <p>Methods</p> <p>Data were collected by means of semi-structured interviews. All the records – defined as 'citations', i.e. a single use reported for a single botanical species by a single informant – were filed in a data base ('analytical table'), together with additional information: i.e. local names of plants, parts used, local frequencies, and habitats of plants, etc. In processing the data, plants and uses were grouped into general ('categories') and detailed ('secondary categories') typologies of use. Some synthetic indexes have also been used, such as Relative Frequency of Citation (RFC), Cultural Importance Index (CI), the Shannon-Wiener Index (H'), and Evenness Index (J).</p> <p>Results</p> <p>Seventy-two plants were cited by the informants as being traditionally used in the area. These 72 'ethnospecies' correspond to 99 botanical taxa (species or subspecies) belonging to 34 families. Three-hundred and one citations, 50 secondary categories of use, and 191 different uses were recorded, most of them concerning alimentary and medicinal plants.</p> <p>For the alimentary plants, 126 citations, 44 species, and 13 different uses were recorded, while for the medicinal plants, there were 106 citations, 40 species, and 12 uses. Few plants and uses were recorded for the remaining categories. Plants and uses for each category of use are discussed. Analyses of results include the relative abundance of botanical families, wild vs. cultivated species, habitats, frequency, parts of plant used, types of use, knowledge distribution, and the different cultural importance of the species in question.</p> <p>Conclusion</p> <p>The study provides examples of several interesting uses of plants in the community, which would seem to show that the custom of using wild plants is still alive in the Monte Ortobene area. However, many practices are no longer in use, and survive only as memories from the past in the minds of elderly people, and often only in one or just a few informants. This rapidly vanishing cultural diversity needs to be studied and documented before it disappears definitively.</p

Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project

BACKGROUND: The objective of this study was to assess the cumulative incidence of invasive candidiasis (IC) in intensive care units (ICUs) in Europe. METHODS: A multinational, multicenter, retrospective study was conducted in 23 ICUs in 9 European countries, representing the first phase of the candidemia/intra-abdominal candidiasis in European ICU project (EUCANDICU). RESULTS: During the study period, 570 episodes of ICU-acquired IC were observed, with a cumulative incidence of 7.07 episodes per 1000 ICU admissions, with important between-center variability. Separated, non-mutually exclusive cumulative incidences of candidemia and IAC were 5.52 and 1.84 episodes per 1000 ICU admissions, respectively. Crude 30-day mortality was 42%. Age (odds ratio [OR] 1.04 per year, 95% CI 1.02-1.06, p&nbsp;&lt; 0.001), severe hepatic failure (OR 3.25, 95% 1.31-8.08, p 0.011), SOFA score at the onset of IC (OR 1.11 per point, 95% CI 1.04-1.17, p 0.001), and septic shock (OR 2.12, 95% CI 1.24-3.63, p 0.006) were associated with increased 30-day mortality in a secondary, exploratory analysis. CONCLUSIONS: The cumulative incidence of IC in 23 European ICUs was 7.07 episodes per 1000 ICU admissions. Future in-depth analyses will allow explaining part of the observed between-center variability, with the ultimate aim of helping to improve local infection control and antifungal stewardship projects and interventions