Restless legs syndrome: differential diagnosis and management with pramipexole

Restless legs syndrome (RLS) is a condition characterized by discomfort at rest and urge to move focused on the legs. RLS may occur as an idiopathic, often hereditary condition (primary RLS), or in association with medical conditions (secondary RLS) including iron deficiency, uremia, and polyneuropathy. Current understanding of the pathophysiology of RLS points to the involvement of three interrelated components: dopaminergic dysfunction, impaired iron homeostasis, and genetic mechanisms. The diagnosis of RLS is made according to the consensus criteria by a National Institutes of Health panel: 1) an urge to move the legs, usually accompanied by uncomfortable sensations; 2) beginning or worsening during rest; 3) relieved by movement; and 4) worse, or only occurring, in the evening or at night. The differential diagnosis of RLS aims to: 1) distinguish RLS from other disorders with RLS-like symptoms and 2) identify secondary forms, with investigation of underlying diseases. The treatment of RLS demands a clinical evaluation to rule out and cure causes of secondary RLS, including iron supplementation when deficient, and to eliminate the triggering factors. The presence of neuropathy should be especially investigated in nonhereditary, late-onset RLS, in view of a possible treatment of the underlying disease. The first line treatment for idiopathic RLS is represented by dopamine agonists, in particular nonergot-derived ropinirole and pramipexole, whereas ergot dopamine agonists (cabergoline and pergolide) are no longer in first-line use given the risks of cardiac valvulopathy. Although no comparative trials have been published, a meta-analysis of pramipexole versus ropinirole suggests differences in efficacy and tolerability favoring pramipexole

Bioavailability of black tea theaflavins: absorption, metabolism, and colonic catabolism

Data obtained with in vitro fecal incubations and a feeding study indicate black tea theaflavin and its galloyl derivatives are not absorbed in detectable amounts in either the upper or lower gastrointestinal tract. The theaflavin skeleton is comparatively resistant to degradation by colonic bacteria with a 67% recovery being obtained after a 24 h incubation, which yielded 21 phenolic and aromatic catabolites. The theaflavin galloyl moiety was removed by the microbiota, and the released gallic acid further transformed to 3-O- and 4-O-methyl gallic acids, pyrogallol-1-sulfate and pyrogallol-2-sulfate, which were excreted in urine in amounts equivalent to 94% of intake. The main urinary product potentially derived from breakdown of the theaflavin skeleton was 3-(4′-hydroxyphenyl)propionic acid. A number of the colonic catabolites originating from gallic acid and theaflavins has been reported to be bioactive in ex vivo and in vitro models with a variety of potential modes of action

Detection and count of Salmonella enterica in pork meat products

A direct plating technique for the enumeration S. enterica in 90 pig meat samples was evaluated in comparison with a three tube-MPN procedure. For the detection of S. enterica the ISO 6597:2002 method was employed. Pork samples were collected at retail level in northern Italy. A total of 15 (16.7%) Salmonella positive samples were detected. By the use of the MPN method, S. enterica was countable m 12 (80.0%) samples, while the direct count gave positive results in two (13.3%) samples only The ISO 6597.2002 method identified 12 (80 %) contaminated samples out of 15. The enumeration levels of S. enterica ranged from 0.03 MPN/g to \u3e 110 MPN/g by the MPN method, and from 10 CFU/g to 180 CFU/g by direct plating. Seven Salmonella serovars were detected. S. Typhimurium, S. Derby, S. Give, S. Rissen, S. Livingstone, S. Brandenburg and S. London, with S. Typhimurium and S. Derby as the predominant ones

Shiga toxin-producing Escherichia coli O157, O26 and O111 in cattle faeces and hides in Italy

Introduction: Ruminants are regarded as the natural reservoir for Shiga toxin-producing Escherichia coli (STEC), especially of serogroup O157. Materials and methods: During 2011 and 2012, 320 samples (160 faecal samples from the rectum and 160 hide samples from the brisket area) were collected from 160 cattle at slaughter in Northern Italy during warm months (May to October). Cattle were reared in different farms and their age at slaughter ranged between nine months and 15 years, most of them being culled cattle (median age: six years; average age: 4.6 years). Samples were tested by immunomagneticseparation technique for E coli O157 and O26 and by a screening PCR for stx genes followed by cultural detection of STEC. The virulence genes stx1, stx2, eae, and e-hlyA were detected and among stx2-positive isolates the presence of the stx2a and stx2c variants was investigated. Results: Twenty-one of 160 cattle (13.1 per cent; 95 per cent CI 8.3 to 19.4 per cent) were found to be faecal carriers of STEC. STEC O157 was found in 10 (6.3 per cent) samples, STEC O26 in six (3.8 per cent) and STEC O111 in one (0.6 per cent). Four isolates (2.5 per cent) were O not determined (OND). Six out of 160 (3.8 per cent; 95 per cent CI 1.4 to 8.0 per cent) hide samples were positive for STEC; four hides (2.5 per cent) were contaminated by STEC O157 and two (1.3 per cent) by STEC O26. In three cattle (1.9 per cent) STEC from both faeces and hides were detected. Among STEC O157, 87.5 per cent of them carried the stx2c gene and 12.5 per cent carried both stx1 and stx2c genes. No O157 isolate harboured stx2a variant. STEC O26 and O111 carried the stx1 gene only. One OND strain carried both the stx2a and stx2c genes. Conclusions: This study shows that STEC O157 from cattle can harbour the stx2c variant, which is associated with haemolytic uraemic syndrome in humans, and that cattle hides may be a source of human pathogenic STEC O157 and O26 in the slaughterhouse environment

Detection, semiquantitative enumeration, and antimicrobial susceptibility of Yersinia enterocolitica in pork and chicken meats in Italy.

Yersinia enterocolitica is recognized as an etiological agent of gastroenteritis, lymphadenitis, and chronic sequelae. During 2006 and 2007, 205 samples (125 pork and 80 chicken meats) were collected in Italy and tested for detection and most-probable-number (MPN) enumeration of Y. enterocolitica organisms. The microorganism was isolated from 45 samples (21.9%): 19 (15.2%) pork samples and 26 (32.5%) chicken samples. Y. enterocolitica MPN contamination levels were low, ranging from 0.30 to 1.50/g. Most (94.4%) Y. enterocolitica strains were biotype 1A (serotypes O:3; O:5; O:6,30; O:6,30-6,31; O:7,8-8-8,19; O:8; O:9; O:25,35; O:36; and O nontypeable), and 5.6% of the isolates were bioserotype 2/O:9. All isolates were tested for yadA, ail, inv, ystA, and ystB virulence sequences. The yadA gene was detected in two strains (3.7%) isolated from chicken samples: one Y. enterocolitica 2/O:9 yadA+ ail+ ystA+, and one Y. enterocolitica 1A/O:7,8-8-8,19 yadA+ inv+ ystB+. Two (3.7%) 2/O:9 strains, isolated from pork products, were ail+ ystA+. Most biotype 1A strains were ystB+ (84.3%) and inv+ (39.2%). All strains were sensitive to cefotaxime, ciprofloxacin, chloramphenicol, nalidixic acid, streptomycin, sulfonamide, tetracycline, trimethoprim, and trimethoprim-sulfamethoxazole. Resistance to gentamicin and aztreonam was observed in 1.9% of the isolates. High levels of resistance were detected toward amoxicillin-clavulanic acid (27.8%), ampicillin (75.9%), and erythromycin (100%). The authors hypothesize that Y. enterocolitica pathogenic biotypes are rather uncommon in foods when compared with their isolation rates from animal sources and that chicken meat could be contaminated as well as pig meat and its derived products

DETECTION OF SALMONELLA ENTERICA IN PIGS AT SLAUGHTER BY THE ISO 6579 METHOD AND THE BacTrac 4300 - IMPEDANCE SYSTEM

Both the ISO 6579:2002 method and the BacTrac 4300 - Impedance system were applied for the detection of Salmonella enterica from pigs at slaughter. A total of 68 pigs, reared in 62 different farms of Northern Italy, were randomly selected during 9 consecutive visits at two slaughter-houses. A total of 204 samples (68 tonsils, 68 samples of caecal matter and 68 ham area carcass swabs) were collected. S. enterica was isolated from 8 (11.8%) tonsils, 17 faecal samples (25.0%) and from 10 (14.7%) carcass swabs. The ISO method detected as positive 6 (75.0%) tonsils, 14 (82.4%) faecal samples and 9 (90.0%) carcasses. S. enterica was isolated from 8 (100%) tonsils, 14 (82.4%) faecal samples and 10 (100%) carcass swabs by the BacTrac 4300 - Impedance system. Salmonella strains serotyping and phagetyping identified 15 S. Derby, 5 S. Agona, 4 S. Rissen, 2 S. Typhimurium phage-type U302, 2 S. Typhimurium DT120, 2 S. enterica 1, 4, [5], 12:i.-, 2 S. Kapemba, 1 S. Give, 1 S. Anatum and 1 S. enterica non-typeable (R strain)

Antimicrobial resistance, biofilm synthesis and virulence genes in Salmonella isolated from pigs bred on intensive farms

Salmonella is the second cause of foodborne infection in humans in the USA and Europe. Pigs represent the second most important reservoir for the pathogen and the consumption of pork meat is a major risk factor for human salmonellosis. Here, we evaluated the virulence patterns of eleven Salmonella isolated from pigs (carcasses and faces) bred in intensive farms in the north of Italy. The two serotypes identified were S. Typhimurium and its monophasic variant 1,4,5,12:i:-. None of the isolates was an ESBL producer, as confirmed also by PCR. However, the presence of a multidrug resistant pattern was evident, with all the isolates being resistant to at least to five antimicrobial agents belonging to various classes. Moreover, six out of eleven isolates showed important resistance profiles, such as resistance against colistin and ciprofloxacin, with nine to twelve recorded resistances. The isolates were negative for the biofilm synthesis test, while four different virulotypes were characterized. All the isolates showed the presence of invA, hilA, stn, ssrA, sipC. One sample also harbored ssaR and spvC genes. One strain was positive for all the virulence genes tested and was resistant to 12 antimicrobial agents. The present study contributes new data to the surveillance program for antibiotic resistance. Furthermore, the presence of eleven highly virulent isolates poses concern for human health in relation to their diffusion in the environment

EVALUATION OF THE INFLUENCE OF PIG HAM POST – SLAUGHTERING REFRIGERATION ON HYGIENIC PARAMETERS SET IN REGULATION EC 2073/2005

In order to evaluate the influence of refrigeration on hygienic parameters, issued by EC Regulation n. 2073:2005 (amended by EC Regulation n. 1441:2007) for swine carcasses, 15 pig hams were tested for microbiological analysis, i.e. enumeration of microorganisms at 30°C and enumeration of enterobacteriacee. Ham swabbing was carried out at the end of slaughtering and after 24 hours of storing in refrigeration cells. The temperature-monitoring recorders were put in the hams at the end of cutting operations of carcasses, when the hams were placed in the refrigeration cells. The drop in the inner temperature of hams was monitored during the 24-hour storing time. In most cases, hams with an increase of background flora after 24 hours, had lower temperature at the beginning of refrigeration and the inner temperature need a shorter time to drop below 20°C, 10°C and 4°C, rather than hams associated with bacterial reduction. Therefore there was no correlation between dropping of temperature and bacterial load of hams, because the hygienic conditions of cutting operations prior to refrigeration have a greater influence on hygienic parameters than refrigeration alone

EFFICIENCY OF VIRAL CONCENTRATION IN FOOD SAMPLES: COMPARISON BETWEEN PEG AND ULTRAFILTRATION TECHNIQUES

Norovirus is the most prevalent causative agent of foodborne diseases. However, the detection of this virus in foods other than shellfish is often time-consuming and unsuccessful. The objective of this study is to compare PEG and ultrafiltration techniques for viral concentration in bivalve molluscs. An experiment with Coxsackie B5 and feline Calicivirus strain F is conduct to determine the efficiency of each virus concentration. Ultrafiltration technique is the most indicated

the role of pigs as pharyngeal carriers of human pathogenic yersinia enterocolitica strains

From March 2007 to January 2008, a total of 170 pigs at slaughter were tested for Y. enterocolitica contamination in tonsils tissue. The animals came from 125 different farms located in four regions of Northern Italy. Y. enterocolitica was isolated from 19 out of 170 (11.2%) tonsils samples. The prevalent bio-serotype (68.4%) was 4/O:3, followed by bioserotypes 1A/O:8 (15.8%), 1A/O:5 (10.5%) and 4/O:8 (5.2%). Among bio-serotype 4/O:3, several strains possessed yadA, ail and ystA virulence genes