Aeromonas spp.: an emerging pathogen?

The aim of this study is to identify and monitor the presence of Aeromonas spp. strains in stool cultures. We analyzed 5564 stool cultures from September 2012 to August 2013. Sixty-three patients were positive for Aeromonas spp. The most frequent symptoms were: diarrhea (46.0%) and abdominal pain (12.7%). Pediatric subjects were 28. Samples' microscopic examination showed leukocytes in 38.1% of cases. It is still controversial whether Aeromonas are responsible for human gastroenteritis, but their presence in faecies of symptomatic patients supports their etiologic role. We propose search for toxins by polymerase chain reaction to identify strains that require an antibiotic therapy

Bowel parasitosis and neuroendocrine tumours of the appendix. A report from the Italian TREP project

Five children with a neuroendocrine tumour (NET) of the appendix associated with a parasitic bowel infection are described, and the possibility of inflammation-triggered carcinogenesis is discussed. Schistosoma haematobium is linked primarily to bladder cancer but it has been reported in association with several other histotypes, including NETs of the gastrointestinal tract. Conversely, Enterobius vermicularis has not yet been claimed to participate in the onset of pre-cancerous conditions or tumours. The rare occurrence of contemporary appendiceal NETs and parasitic infection, raises the intriguing hypothesis of an inflammation-related carcinogenesis, although a cause-effect relationship cannot be established. Larger international series of childhood appendiceal NETs, which also include countries with higher prevalence of parasitic bowel infections, are needed to further clarify this possible cause-effect relationshi

Comparative analysis of objective and subjective outcomes of two different intraocular lenses: trifocal and extended range of vision

Objective: To evaluate objective and subjective outcomes after bilateral implantation of two different multifocal intraocular lenses, which correct pseudophakic presbyopia in an adequate and homogeneous population court. Methods and analysis: Fifty patients were evaluated at 3 months after bilateral implantation, at the Eye Clinic of University of Verona and at the Carones Ophthalmology Center Milano, as follows: Tecnis Symfony (25 patients), Alcon PanOptix (25 patients). Main outcomes were uncorrected and best-corrected distance visual acuity (UDVA and BCVA) at 4 m, 60 cm (best distance corrected intermediate visual acuity (BDCIVA) and uncorrected intermediate visual acuity), 40 cm (best distance corrected near visual acuity (BDCNVA) and uncorrected near visual acuity (UNVA)), objective refractive outcome, defocus curve, contrast sensitivity (Modulation Transfer Function (MTF) cut-off), optical quality (Strehl ratio), aberrometry (root mean square RMS 4 mm), subjective quality of life (National Eye Institute Refractive Error Quality of Life score (NEI-RQL-42 score) test). Results: Symfony and PanOptix showed BCVA and UDVA comparable results. Symfony presented significant better outcomes at BDCIVA (p=0.001), while PanOptix showed better performances at BDCNVA and UNVA (p=0.01). Symfony achieved better results in RMS 4 mm (p=0.024) and in MTF cut-off (p=0.041). In the questionnaire NEI-RQL-42, PanOptix presented better scores in 'near vision' and 'spectacles independence', whereas Symfony in 'symptoms' and 'clarity of vision'. Conclusion: Both intraocular lenses are valid options to avoid pseudophakic presbyopia, even though they present different features which make them unique. Symfony allows patients to achieve a better objective and subjective quality of vision and contrast sensitivity; PanOptix provides better outcomes in near vision and spectacles independence requirements

Emphysema distribution and diffusion capacity predict emphysema progression in human immunodeficiency virus infection

Background Chronic obstructive pulmonary disease (COPD) and emphysema are common amongst patients with human immunodeficiency virus (HIV). We sought to determine the clinical factors that are associated with emphysema progression in HIV. Methods 345 HIV-infected patients enrolled in an outpatient HIV metabolic clinic with \uf42 chest computed tomography scans made up the study cohort. Images were qualitatively scored for emphysema based on percentage involvement of the lung. Emphysema progression was defined as any increase in emphysema score over the study period. Univariate analyses of clinical, respiratory, and laboratory data, as well as multivariable logistic regression models, were performed to determine clinical features significantly associated with emphysema progression. Results 17.4% of the cohort were emphysema progressors. Emphysema progression was most strongly associated with having a low baseline diffusion capacity of carbon monoxide (DLCO) and having combination centrilobular and paraseptal emphysema distribution. In adjusted models, the odds ratio (OR) for emphysema progression for every 10% increase in DLCO percent predicted was 0.58 (95% confidence interval [CI] 0.41-0.81). The equivalent OR (95% CI) for centrilobular and paraseptal emphysema distribution was 10.60 (2.93-48.98). Together, these variables had an area under the curve (AUC) statistic of 0.85 for predicting emphysema progression. This was an improvement over the performance of spirometry (forced expiratory volume in 1 second to forced vital capacity ratio), which predicted emphysema progression with an AUC of only 0.65. Conclusion Combined paraseptal and centrilobular emphysema distribution and low DLCO could identify HIV patients who may experience emphysema progression

Thymus Imaging Detection and Size Is Inversely Associated With Metabolic Syndrome and Frailty in People With HIV

People with HIV (PWH) may experience accentuating aging in relation to immuno-activation. Little is known regarding thymus (THY) involution in this process. We sought to investigate the relationship between THY imaging detection/size and clinically relevant aging outcomes such as metabolic syndrome (MetS), multimorbidity (MM), and frailty in PWH

Molecular Imaging of Vascular Calcification with 18 F-Sodium-Fluoride in Patients Infected with Human Immunodeficiency Virus

18F-Sodium Fluoride (NaF) accumulates in areas of active hydroxyapatite deposition and potentially unstable atherosclerotic plaques. We assessed the presence of atherosclerotic plaques in 50 adult patients with HIV (HIV+) who had undergone two cardiac computed tomography scans to measure coronary artery calcium (CAC) progression. CAC and its progression are predictive of an unfavorable prognosis. Tracer uptake was quantified in six arterial territories: aortic arch, innominate carotid artery, right and left internal carotid arteries, left coronary (anterior descending and circumflex) and right coronary artery. Thirty-one patients showed CAC progression and 19 did not. At least one territory with high NaF uptake was observed in 150 (50%) of 300 arterial territories. High NaF uptake was detected more often in non-calcified than calcified areas (68% vs. 32%), and in patients without than in those with prior CAC progression (68% vs. 32%). There was no correlation between clinical and demographic variables and NaF uptake. In clinically stable HIV+ patients, half of the arterial territories showed a high NaF uptake, often in the absence of macroscopic calcification. NaF uptake at one time point did not correlate with prior progression of CAC. Prospective studies will demonstrate the prognostic significance of high NaF uptake in HIV+ patients

The impact of chest CT body composition parameters on clinical outcomes in COVID-19 patients

We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality.We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/ 27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality

Aeromonas spp.: an emerging pathogen?

The aim of this study is to identify and monitor the presence of Aeromonas spp. strains in stool cultures. We analyzed 5564 stool cultures from September 2012 to August 2013. Sixty-three patients were positive for Aeromonas spp. The most frequent symptoms were: diarrhea (46.0%) and abdominal pain (12.7%). Pediatric subjects were 28. Samples’ microscopic examination showed leukocytes in 38.1% of cases. It is still controversial whether Aeromonas are responsible for human gastroenteritis, but their presence in faecies of symptomatic patients supports their etiologic role. We propose search for toxins by polymerase chain reaction to identify strains that require an antibiotic therapy

HIV patients exhibit similar rates of emphysema progression observed in older HIV-uninfected patients with higher cumulative smoke exposure.

HIV patients face the burden of chronic obstructive pulmonary disease (COPD). How quickly COPD phenotypes such as emphysema progress, what risk factors are associated with COPD progression in an HIV-infected population, and whether this risk of progression is in excess compared to HIV-uninfected patients are unknown

Real Time PCR for Dientamoeba fragilis: a comparison between molecular and microscopical approach

Introduction. Dientamoeba fragilis is an intestinal protozoan parasite that is attracting growing interest. Several authors have associated the presence of this faecal agent to numerous intestinal and systemic clinical symptoms, even though asymptomatic carriers have been reported.Actually, to perform the coproparasitology exam for the identification of D. fragilis it is necessary to recur to an expert microscopist. Recently, several real-time TaqMan assays for the detection of D. fragilis has been reported. In this work we validate an original real-time PCR (TaqMan), re-evaluating the traditional microscopic diagnosis. Moreover, the potential for quantitative information, intrinsic of this molecular technique, was preliminarly explored. Methods. Forty-six carriers of D. fragilis were selected from patients referred to the Service of Microbiology of Padova University Hospital. The parasite was preliminarily detected on several occasions in each patient using traditional microscopy. A control group included forty-two healthy volunteers. Real-time PCR was applied to a stool sample from each subject. On the same sample, gel-electrophoresis amplicon detection PCR and microscopic examination were also performed. Results. The sensitivity of real-time PCR was 100%, whereas microscopy showed 93% sensitivity (direct wet mount on fixed stools and trichrome stain), gel-electrophoresis PCR 76% and Giemsa stain 52%.The specificity of all methods was 100%. On the quantitative side, the frequency distribution of the protozoan load of the stools revealed a near to log-normal pattern is apparent for the data yielded by real-time PCR. Conclusions. The real-time PCR was clearly superior to either the gel electrophoresis PCR or the traditional microscopic examination. Just one unpreserved stool sample was adequate to find the parasite. The entire procedure could be performed within a few hours avoiding toxic dyes