A case-report of a pulmonary tuberculosis with lymphadenopathy mimicking a lymphoma.

Abstract Clinical and radiological manifestations of tuberculosis (TB) are heterogeneous, and differential diagnosis can include both benign and malignant diseases (e.g., sarcoidosis, metastatic diseases, and lymphoma). Diagnostic dilemmas can delay appropriate therapy, favoring Mycobacterium tuberculosis transmission. We report on a case of TB in an immunocompetent, Somalian 22-year-old boy admitted in the respiratory unit of an Italian university hospital. His symptoms and clinical signs were thoracic pain, weight loss, latero-cervical, mediastinal, and abdominal lymphadenopathy. Smear microscopy and PCR were negative for Mycobacterium tuberculosis . The unclear histological pattern, the unusual clinical presentation, the CT scan signs, the BAL lymphocytes suggested the suspicion a lymphoma. Culture conversion proved Mycobacterium tuberculosis infection. This case report highlights the risk of misdiagnosis in patients with generalized lympho-adenopathy and pulmonary infiltrates, particularly in Africans young patients

The diet and haemodialysis dyad: Three eras, four open questions and four paradoxes. A narrative review, towards a personalized, patient-centered approach

The history of dialysis and diet can be viewed as a series of battles waged against potential threats to patientsâ\u80\u99 lives. In the early years of dialysis, potassium was identified as â\u80\u9cthe killerâ\u80\u9d, and the lists patients were given of forbidden foods included most plant-derived nourishment. As soon as dialysis became more efficient and survival increased, hyperphosphatemia, was identified as the enemy, generating an even longer list of banned aliments. Conversely, the â\u80\u9cthird eraâ\u80\u9d finds us combating protein-energy wasting. This review discusses four questions and four paradoxes, regarding the diet-dialysis dyad: are the â\u80\u9cmagic numbersâ\u80\u9d of nutritional requirements (calories: 30â\u80\u9335 kcal/kg; proteins > 1.2 g/kg) still valid? Are the guidelines based on the metabolic needs of patients on â\u80\u9cconventionalâ\u80\u9d thrice-weekly bicarbonate dialysis applicable to different dialysis schedules, including daily dialysis or haemodiafiltration? The quantity of phosphate and potassium contained in processed and preserved foods may be significantly different from those in untreated foods: what are we eating? Is malnutrition one condition or a combination of conditions? The paradoxes: obesity is associated with higher survival in dialysis, losing weight is associated with mortality, but high BMI is a contraindication for kidney transplantation; it is difficult to limit phosphate intake when a patient is on a high-protein diet, such as the ones usually prescribed on dialysis; low serum albumin is associated with low dialysis efficiency and reduced survival, but on haemodiafiltration, high efficiency is coupled with albumin losses; banning plant derived food may limit consumption of â\u80\u9cvascular healthyâ\u80\u9d food in a vulnerable population. Tailored approaches and agreed practices are needed so that we can identify attainable goals and pursue them in our fragile haemodialysis populations

Notulae to the Italian alien vascular flora: 12

In this contribution, new data concerning the distribution of vascular flora alien to Italy are presented. It includes new records, confirmations, exclusions, and status changes for Italy or for Italian administrative regions. Nomenclatural and distribution updates published elsewhere are provided as Suppl. material 1

Notulae to the Italian alien vascular flora: 11

In this contribution, new data concerning the distribution of vascular flora alien to Italy are presented. It includes new records, confirmations, exclusions, and status changes for Italy or for Italian administrative regions. Nomenclatural and distribution updates published elsewhere are provided as Suppl. material 1

Indici strutturali e di competizione per la caratterizzazione di popolamenti cedui di castagno

Structural and competition indexes to characterise chestnut coppice stands. Structure, tree density and variation of tree specific composition are parameters useful to describe both natural dynamics and competition processes. In the field forestry, synthetic indices descriptive of both specific - structural diversity and competition are used, especially for high forests. In the present paper, the relations between silvicultural treatment and some synthetic indices descriptive of thinned chestnuts coppice stands differently aged are analysed. The main goals of the paper are: i) to verify the application of some in coppice stands, to evaluate their adaptation to differentiate and quantify the structural complexity, stand dynamics and competition processes as a function of past silvicultural history; ii) to ascertain the utility of the indices for the planning of future thinnings. The study was carried out in three experimental plots of the “Altopiano delle Pizzorne, (Lu)”. The stands analysed are differently aged (43 and 64 years) and as for silvicultural background which affected both the present structure and the ongoing competitive process. The detailed of stands structure analysis was carried out within experimental areas (1200m2), besides manserational parameters, data necessary to determine the competition indices were acquired. Data analysis led to determine synthetic indices of distributive, structural and specific diversity. The analysed stands show a one-storied, monospecifici structure with a tree distribution from regular to random and reduced level of individual competition. The chosen indices describe the effect of the applied treatment and show that the analysed stands are not characterized by the clustered distribution typical of coppices. The active silvicultural treatment determines the simplification of the stand structure. Furthermore, the selected indices, synthetic and easy to calculate, represent a useful operational instrument in silvicultural planning.</span

Phenylpropenoids from Bupleurum fruticosum as Anti-Human Rhinovirus Species A Selective Capsid Binders

The dichloromethane extract of the leaves of Bupleurum fruticosum was found to inhibit the replication of human rhinovirus (HRV) serotypes 14 and 39. Bioassay-guided fractionation led to the isolation of seven phenylpropenol derivatives (3-9), two polyacetylenes (1 and 2), and one monoterpene (10). Compounds 1 and 10 were identified as previously undescribed secondary metabolites after extensive 1D and 2D NMR experiments as well as high-resolution mass spectrometry. Compounds 2, 4, and 5 showed a selective inhibition of viral replication against HRV39 serotype, with 2 and 4 being the most active, with EC50values of 1.8 ± 0.02 and 2.4 ± 0.04 μM. Mechanism of action studies indicated that 4 behaves not only as a capsid binder, interfering with the early phases of virus replication, but also as a late-phase replication inhibitor. Docking experiments were performed to confirm the ability of the antiviral phenylpropenoids to selectively fit into the hydrophobic pocket of VP1-HRV39

Preeclampsia is a valuable opportunity to diagnose chronic kidney disease: a multicentre study

Background: Preeclampsia (PE) and chronic kidney disease (CKD) are known to be associated. Our objective was to assess the prevalence CKD in a large multicenter cohort of women without acknowledged CKD who experienced a PE episode. Methods: Setting: France (Le Mans, Central France) and Italy (Cagliari, Sardinia).Participants: Patients who experienced PE in 2018-2019, identified from the obstetric charts. Patients with known-acknowledged CKD were excluded. Only singletons were considered.Persistent (micro)albuminuria was defined as present and confirmed at least 3 months after delivery. CKD was defined according to the KDOQI guidelines; urinary alterations or low eGFR confirmed at least 3 months of distance, or morphologic changes. Patients were divided into 4 groups: evidence of CKD; no evidence of CKD; unclear diagnosis-ongoing work-up; persistent microalbuminuria. The outcome "diagnosis of CKD" was analyzed by simple and multiple logistic regressions. Temporal series (week of delivery) were analyzed with Kaplan-Meier curves and Cox analysis. Results: Two-hundred-eighty-two PE pregnancies were analyzed (Le Mans: 162; Cagliari: 120). The incidence of CKD diagnosis was identical (Le Mans: 19.1%; Cagliari: 19.2%); no significant difference was found in unclear-ongoing diagnosis (6.2%; 5.8%) and microalbuminuria (10.5%; 5.8%). Glomerulonephritis and diabetic nephropathy were more frequent in Cagliari (higher age and diabetes prevalence), interstitial diseases in Le Mans. In the multivariate logistic regression, CKD diagnosis was associated with preterm delivery (adjusted p = 0.035). Gestation was one week shorter in patients diagnosed with CKD (Kaplan Meier p = 0.007). In Cox analysis CKD remained associated with shorter gestation after adjustment for age and parity. Conclusions: The prevalence of newly diagnosed CKD is high after PE (19% vs expected 3% in women in childbearing age), supporting a systematic nephrology work-up after PE

Dietary satisfaction and quality of life in chronic kidney disease patients on low-protein diets: a multicentre study with long-term outcome data (TOrino-Pisa study)

BACKGROUND: Concerns about adherence and quality of life (QoL) limit the diffusion of low-protein diets (LPDs) as a way to slow chronic kidney disease (CKD) progression and postpone dialysis. The aim of this multicentre study is to assess dietary satisfaction in stable CKD patients. METHODS: This was a multicentre cross-sectional study with long-term follow-up data. Prevalent patients on LPD for at least 6 months were selected in four Italian centres. QoL was assessed using the World Health Organization Quality of Life questionnaire, and diet satisfaction with the Modification of Diet in Renal Disease satisfaction questionnaire. Comorbidity was assessed by Charlson Comorbidity Index, estimated glomerular filtration rate (eGFR) was calculated by the CKD Epidemiology Collaboration equation and protein intake by Maroni-Mitch formula. Survival was analysed with Kaplan-Meier curves and Cox Proportional Hazard Model. RESULTS: Four hundred and twenty-two CKD Stages 3-5 patients were enrolled. Over 95% were on moderately restricted diets (0.6 g/kg/day). Compliance was good (protein intake: 0.59 g/kg/day at baseline, 0.72 at the end of follow-up). Median dietary satisfaction was 4 on a 1-5 scale. QoL was not affected by the type of diet, but was influenced by age, comorbidity and setting of care. Two years later, at the end of follow-up, 66.6% of the patients were still on a diet; the main causes of discontinuation were dialysis and death. The dropout rate was low (5.5%); in Cox analysis, patient and renal survival were influenced by age and eGFR, but not by QoL, setting of care or type of diet. CONCLUSIONS: LPDs are compatible with high dietary satisfaction and minimal dropout, at least in patients who are able to follow such a diet for at least 6 months

Ferulic Acid Esters and Withanolides: in Search of Withania somnifera GABAA Receptor Modulators

Nine compounds, including two undescribed withanolides, withasomniferolides A and B (1 and 2), three known withanolides (3-5), a ferulic acid dimeric ester (6), and an inseparable mixture of three long alkyl chain ferulic acid esters (7-9) were isolated from a GABAA receptor positive activator methanol extract of the roots of Withania somnifera. The structures of the isolated compounds were elucidated based on NMR, MS and ECD data analysis. In order to bioassay the single ferulic acid derivatives, compounds 6-9 were also synthesized. The most active compound, docosanyl ferulate (9), was able to enhance the GABAA receptor inhibitory postsynaptic currents with an IC50 value of 7.9 µM. These results, by showing an ability to modulate the GABAA receptor function, cast fresh light on the biological activities of the secondary metabolites of W. somnifera roots