Safety and impact on diagnostic accuracy of early analgesia in suspected acute appendicitis: A meta-analysis

n/

Prevalence of Coxiella burnetii in cows' and ewes' bulk tank milk samples from selected dairy farms of Central Italy

The prevalence of Coxiella burnetii, the causative agent of Q fever, in cattle and sheep raw milk farms was determined in Central Italy, an area in which dairy production plays an important economic role. Milk samples (n. 189), collected from 66 dairy farms in 2012–2013, were tested by a commercial real-time PCR assay. Seventeen dairy farms had at least one positive milk sample; percent positive was higher for cattle (50%) than sheep (21%) farms. Concerning milk, 15% of samples tested overall gave a positive result, with the highest percentage of positivity observed for bovine milk compared with sheep milk (41% and 12%, respectively). In the only bovine farm repeatedly sampled during the study, C. burnetii contamination was persistently found for almost a year. The prevalence calculated for the sheep farms showed a discontinuous trend with a maximum peak in February. The results obtained underline the widespread presence of the pathogen in the considered geographical area, giving new epidemiological information. Since the milk route of elimination is a potential vehicle of infection for farmers, veterinarians and for dairy stakeholders in general, BTM screening by real-time PCR can be applied as a useful surveillance tool both for the identification of infected flocks and implementation of control programmes

Appendiceal Neuroendocrine Tumors and Anorectal Melanoma

Tumor growth and spread are a complicated matter and are the result of many interconnected factors. The analysis of patterns emerging from highly numerous populations might help shed some light on such an intricate mechanism. In this respect, our studies are mostly based on the SEER database, a nation representative dataset collecting data regarding the US population, over a very long time span. This approach is revealed to be particularly useful for rare tumors, as prospective studies are not feasible. Here, we present the results and the clinical implications of our inquires: we show the impact on overall survival of several morphological and demographic characteristics of various malignancies including anorectal melanoma and neuroendocrine tumors of the appendix. The impact of surgical treatment is discussed as well. Finally, we endorse the need to find more reliable markers of tumor biology, such as genetic patterns, to tailor an effective multidisciplinary treatment

TERT Promoter Mutations in Papillary Thyroid Microcarcinomas

Small papillary thyroid carcinomas have contributed to the worldwide increased incidence of differentiated thyroid cancer observed over the past decades. However, the mortality rate has not changed over the same period of time, raising questions about the possibility that thyroid cancer patients, especially those with small tumors, are overdiagnosed and overtreated. Molecular prognostic marker able to discriminate aggressive thyroid cancers from those with an indolent course would be of great relevance to tailor the therapeutic approach and reduce overtreatment. Mutations in the TERT promoter were recently reported to correlate strongly with aggressiveness in advanced forms of thyroid cancer, holding promise for a possible clinical application. The occurrence and potential clinical relevance of TERT mutations in papillary thyroid microcarcinomas (mPTCs) is currently unknown. This study aimed to analyze the occurrence of two TERT promoter mutations (-124C>T and -146C>T) and their potential association with unfavorable clinical features in a large cohort of mPTCs

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

Laparoscopic versus open appendectomy in obese patients: A meta-analysis of prospective and retrospective studies

Background: A meta-analysis of different kinds of studies was performed to assess outcomes of laparoscopic versus open appendectomy in obese patients. Materials and Methods: Retrospective and prospective studies enrolling patients with a body mass index greater than 30 kg/m 2 were included. Primary outcomes were days of hospital stay, surgical procedure duration, and overall post-operative complication rate. Secondary outcomes were wound infection and intra-abdominal abscesses formation rate, hospital charges. Results: Laparoscopic appendectomy showed to be significantly associated with lower wound infection (P < 0.001) and post-operative complication rate (P < 0.001). Surgical time was considered as a hallmark of technical challenge and resulted diminished in the laparoscopic group (P = 0.018). Although not clinically relevant per se, the statistically significant shorter hospital stay (P < 0.001) was probably the reason of decreased hospital charges (P < 0.001). Intra-abdominal abscesses formation rate was higher in the open appendectomy group (P = 0.058), although slightly above the statistical significance threshold. Conclusion: Laparoscopic approach seemed to show relevant advantages compared to open appendectomy, but a large prospective trial is necessary to collect high quality data and investigate long-term outcomes

Giant Intrathoracic Schwannoma of the left vagus nerve presenting as atrial fibrillation

Posterior mediastinal tumors are not infrequent, and among them neurogenic masses and schwannomas are the most common histological variety. They are benign, initially asymptomatic tumors and later become symptomatic due to the mass effect. Surgical excision is the preferred therapy and the approach can be evaluated according to the dimensions of the lesion. We report the case of a giant schwannoma, originating from the left vagus nerve, in a middle-aged woman whose symptoms were exertion-induced dyspnoea and atrial fibrillation

Prevalence of Coxiella burnetii in cows’ and ewes’ bulk tank milk samples from selected dairy farms of Central Italy

The prevalence of Coxiella burnetii, the causative agent of Q fever, in cattle and sheep raw milk farms was determined in Central Italy, an area in which dairy production plays an important economic role. Milk samples (n. 189), collected from 66 dairy farms in 2012–2013, were tested by a commercial real-time PCR assay. Seventeen dairy farms had at least one positive milk sample; percent positive was higher for cattle (50%) than sheep (21%) farms. Concerning milk, 15% of samples tested overall gave a positive result, with the highest percentage of positivity observed for bovine milk compared with sheep milk (41% and 12%, respectively). In the only bovine farm repeatedly sampled during the study, C. burnetii contamination was persistently found for almost a year. The prevalence calculated for the sheep farms showed a discontinuous trend with a maximum peak in February. The results obtained underline the widespread presence of the pathogen in the considered geographical area, giving new epidemiological information. Since the milk route of elimination is a potential vehicle of infection for farmers, veterinarians and for dairy stakeholders in general, BTM screening by real-time PCR can be applied as a useful surveillance tool both for the identification of infected flocks and implementation of control programmes

Colostomy Reversal following Hartmann&rsquo;s Procedure: The Importance of Timing in Short- and Long-Term Complications: A Retrospective Multicentric Study

The restoration of bowel continuity following Hartmann&rsquo;s Procedure (HP) has been reported hitherto with high morbidity and mortality rates. No clear guidelines exist about timing in Hartmann&rsquo;s Reversal (HR), the literature data being conflicting. We have sought to investigate the effect of the interval time between HP and HR in short- and long-term HR outcomes through a retrospective study based on consecutive patients undergoing HR between 2009 and 2017 in two regional hospitals in Italy. Demographic characteristics, comorbidities, intra- and post-operative data, as well as early complications, were recorded. Long-term data were collected on the surgical site occurrences of Incisional Ventral Hernia (IVH). One hundred and five patients were recruited for the study. Late HR, female gender, and long operating time were related to the highest incidence of peri-operative complications. Patients who developed IVH had undergone HR at significantly shorter times and had a higher Body Mass Index (BMI). The timing of HR seems to be an important variable linked to the onset of early and late post-operative complications. The patients submitted to early HR show a significantly lower complication rate but, at the same time, a higher rate of IVH incidence after restorative surgery. These data, in our opinion, reflect the need for planning, where possible, an early restoration of bowel continuity after HP