APLICACIÓN DE COMPETENCIAS EN EL ÁREA DE GEOLOGÍA EN EL PROYECTO TUNING

Tuning América Latina es un trabajo conjunto que busca y construye lenguaje y sistemas de carácter transicional y transregional. En el marco del Proyecto Alfa Tuning América Latina se constituyó el grupo del área de geología (año 2006), conformado por representantes de universidades de los países de América Latina. El objetivo general es aplicar las competencias genéricas y específicas en dicha área. Ha sido concebido como un espacio de reflexión de actores comprometidos con la educación profesional, que a través de la búsqueda de consensos, avancen en el desarrollo de titulaciones fácilmente comparables y comprensibles de forma articulada en toda América Latina. La idea de llevar adelante una propuesta como la de Tuning en América Latina, surge en Europa pero planteados por latinoamericanos. La metodología empleada se fundamentó en las consultas sobre los comportamientos específicos notándose coincidencias en los procesos de formación académica en todos los países de América Latina que participaron, aplicándose un método estadístico descriptivo, considerándose el cálculo de la media y la desviación estándar de la variable obtenida de las encuestas. Se analizó y discutió el panorama del área temática en los distintos países, se analizaron las competencias genéricas elaboradas en etapas anteriores del proyecto, se definieron las competencias específicas y los métodos de consulta para su evaluación. En los resultados se resalta la importancia de obtener un espectro amplio, tanto de países e instituciones con el fin de consolidar dicho proyecto

Primary Prophylaxis of Invasive Fungal Diseases in Allogeneic Stem Cell Transplantation: Revised Recommendations from a Consensus Process by Gruppo Italiano Trapianto Midollo Osseo (GITMO)

Abstract This document updates and expands the recommendations on primary prophylaxis of invasive fungal diseases (IFD) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients, published in 2009 by the Gruppo Italiano Trapianto Midollo Osseo (GITMO). A consensus process was undertaken to describe and evaluate current information and practice regarding risk stratification and primary antifungal prophylaxis during the pre-engraftment and postengraftment phases after allo-HSCT. The revised recommendations were based on the evaluation of recent literature including a large, prospective, multicenter epidemiological study of allo-HSCT recipients conducted among the GITMO transplantation centers during the period of 2008 to 2010. It is intended as a guide for the identification of types and phases of transplantation at low, standard, and high risk for IFD, according to the underlying disease, transplantation, and post-transplantation factors. The risk stratification was the critical determinant of the primary antifungal approach for allo-HSCT recipients

Role of SIRT-3, p-mTOR and HIF-1\u3b1 in Hepatocellular Carcinoma Patients Affected by Metabolic Dysfunctions and in Chronic Treatment with Metformin

The incidence of hepatocellular carcinoma deriving from metabolic dysfunctions has increased in the last years. Sirtuin- (SIRT-3), phospho-mammalian target of rapamycin (p-mTOR) and hypoxia-inducible factor- (HIF-1\u3b1) are involved in metabolism and cancer. However, their role in hepatocellular carcinoma (HCC) metabolism, drug resistance and progression remains unclear. This study aimed to better clarify the biological and clinical function of these markers in HCC patients, in relation to the presence of metabolic alterations, metformin therapy and clinical outcome. A total of 70 HCC patients were enrolled: 48 and 22 of whom were in early stage and advanced stage, respectively. The expression levels of the three markers were assessed by immunohistochemistry and summarized using descriptive statistics. SIRT-3 expression was higher in diabetic than non-diabetic patients, and in metformin-treated than insulin-treated patients. Interestingly, p-mTOR was higher in patients with metabolic syndrome than those with different etiology, and, similar to SIRT-3, in metformin-treated than insulin-treated patients. Moreover, our results describe a slight, albeit not significant, benefit of high SIRT-3 and a significant benefit of high nuclear HIF-1\u3b1 expression in early-stage patients, whereas high levels of p-mTOR correlated with worse prognosis in advanced-stage patients. Our study highlighted the involvement of SIRT-3 and p-mTOR in metabolic dysfunctions that occur in HCC patients, and suggested SIRT-3 and HIF-1\u3b1 as predictors of prognosis in early-stage HCC patients, and p-mTOR as target for the treatment of advanced-stage HCC

Focolaio di COVID-19 in un campo estivo nella Regione Piemonte (2021): descrizione, lezioni apprese e raccomandazioni per futuri campi estivi

COVID-19 outbreak at a summer camp in Piedimont region in 2021: description, lessons learned and recommendations for future summer camps Introduction In August 2021, an outbreak of coronavirus disease 2019 (COVID-19) occurred in a summer camp in Piedmont region, Italy, affecting primarily campers aged ≤16 years. We conducted a retrospective cohort study among campers and personnel (attendees) to determine the attack rate (AR), evaluate possible factors associated with transmission and propose recommended measures for the organization of future summer camps. Materials and methods A de-identified database including demographic, role of attendees, cohorting, means of transportation to the camp, inter-camper interactions, SARS-CoV-2 testing results and symptomatology was used. All analysis data came from a collection of data carried out by the organizing private company and the information related to the mitigation protocol put in place was provided by the health care personnel. All campers were asked to have an antigen/molecular test within 72 hours before departure. Nine dedicated buses departed from different Italian regions towards the camp. All travellers wore a surgical mask during the trip. Upon arrival, regardless of the bus used, the campers were divided into 11 subgroups with no further contact between them unless they were blood relatives. No SARS-CoV-2 screening tests were scheduled for campers after arrival and during the camp period. On the other hand, personnel had a screening test at each shift change. During the camp period, antigen tests were performed at cases with symptoms suggestive of infection. Only attendees enrolled in the private company and those who received at least one test since arrival at the camp were considered in the study. We calculated overall AR and relative risk (RR) along with specific, transmission-focused risk factors. Results Among the 187 study participants, the median age was 14 years (range: 6-45). Seven days after arrival at the camp, 8 campers developed symptoms and tested positive. The overall AR was 33.7% (63 out of 187), and 34.2% (50/146) for campers and 31.7% (13/41) for staff, respectively. Among those with available symptoms information, 72% (36/50) were asymptomatic at the time of testing. Only 17.1% of campers had direct contact with blood relatives from other subgroups. The AR of participants using a bus was 36.2% (59/163) with an RR of 1.18 (95% CI = 0.51-2.73,) and the AR of those belonging to a subgroup was 35% (62/177) with an RR of 3.5 (95% CI = 0.54-22.7). For personnel, participation to a subgroup gave an AR of 38.7% (12/31) and an RR of 3.87 (95% CI = 0.57-26.18). All but four subgroups had a high AR (>33,3). Conclusions Getting tested prior to traveling and campers separation into low-contact subgroups was not sufficient enough to avoid a high number of infections in this summer camp. Analysis did not allow the identification of an index case or helped to understand whether the outbreak originated from the attendees who travelled on the same bus. The high AR observed in all subgroups suggest that there was frequent contact between attendees belonging to different subgroups. Sharing of common areas such as the canteen and contact between attendees are possible factors that have contributed to the spread of the outbreak. The experience gained by the analysis of this data was used for the review of measures for the organization of summer camps in 2022

The baseline comorbidity burden affects survival in elderly patients with acute myeloid leukemia receiving hypomethylating agents: Results from a multicentric clinical study

Background: In older patients with acute myeloid leukemia (AML), the definition of fitness, prognosis, and risk of death represents an open question. Methods: In the present study, we tested the impact on survival of disease- and patient-related parameters in a large cohort of elderly AML patients homogeneously assigned to treatment with hypomethylating agents (HMAs). Results: In 131 patients with a median age of 76 years, we confirmed that early response (<0.001) and biology-based risk classification (p = 0.003) can select patients with better-predicted survival. However, a full disease-oriented model had limitations in stratifying our patients, prompting us to investigate the impact of baseline comorbidities on overall survival basing on a comorbidity score. The albumin level (p = 0.001) and the presence of lung disease (p = 0.013) had a single-variable impact on prognosis. The baseline comorbidity burden was a powerful predictor of patients' frailty, correlating with increased incidence of adverse events, especially infections, and predicted overall survival (p < 0.001). Conclusion: The comorbidity burden may contribute to impact prognosis in addition to disease biology. While the therapeutic armamentarium of elderly AML is improving, a comprehensive approach that combines AML biology with tailored interventions to patients' frailty is likely to fully exploit the anti-leukemia potential of novel drugs

Prediction of early recurrent thromboembolic event and major bleeding in patients with acute stroke and atrial fibrillation by a risk stratification schema: the ALESSA score study

Background and Purposes—This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. Methods—The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00–1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08–2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30–1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632–0.763; P=0.0001) for ischemic outcome events and 0.585 (0.493–0.678; P=0.10) for major bleedings. Results—The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529–0.763; P=0.009) for ischemic outcome events and 0.407 (0.275–0.540; P=0.14) for hemorrhagic outcome events. Conclusions—In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p < .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p < .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come

A telerehabilitation platform for cognitive, physical and behavioural rehabilitation in elderly patients affected by dementia

Dementia is one of the main causes of disability in elderly people and its treatment becomes, year after year, an increasingly compelling priority for the public health system. In the last years, home assistance and telemedicine have paved the way to decrease the treatments’ costs and to improve the patients and caregivers quality of life quality. In this framework, the aim of ABILITY project is to design, develop and validate an integrated platform of services aimed at supporting and enhancing the rehabilitation process for patients with dementia at their homes. ABILITY platform allows the clinician to assign rehabilitation plans with a strong compliance monitoring, enabled by the technological solutions integrated, and the holistic approach to rehabilitation, as the plan includes physical, cognitive and behavioral therapies/exercises. The ABILITY platform will be assessed through a set of validation activities, involving a small group of pilot patients, and a Randomized Control Trial. In conclusion, the ABILITY project generates a series of assistive services inside a modular and flexible platform, adaptable to the single patient and his/her needs, increasing the treatment efficiency and efficacy with respect to the state of the art

An explainable model of host genetic interactions linked to COVID-19 severity

We employed a multifaceted computational strategy to identify the genetic factors contributing to increased risk of severe COVID-19 infection from a Whole Exome Sequencing (WES) dataset of a cohort of 2000 Italian patients. We coupled a stratified k-fold screening, to rank variants more associated with severity, with the training of multiple supervised classifiers, to predict severity based on screened features. Feature importance analysis from tree-based models allowed us to identify 16 variants with the highest support which, together with age and gender covariates, were found to be most predictive of COVID-19 severity. When tested on a follow-up cohort, our ensemble of models predicted severity with high accuracy (ACC = 81.88%; AUCROC = 96%; MCC = 61.55%). Our model recapitulated a vast literature of emerging molecular mechanisms and genetic factors linked to COVID-19 response and extends previous landmark Genome-Wide Association Studies (GWAS). It revealed a network of interplaying genetic signatures converging on established immune system and inflammatory processes linked to viral infection response. It also identified additional processes cross-talking with immune pathways, such as GPCR signaling, which might offer additional opportunities for therapeutic intervention and patient stratification. Publicly available PheWAS datasets revealed that several variants were significantly associated with phenotypic traits such as "Respiratory or thoracic disease", supporting their link with COVID-19 severity outcome.A multifaceted computational strategy identifies 16 genetic variants contributing to increased risk of severe COVID-19 infection from a Whole Exome Sequencing dataset of a cohort of Italian patients