[Stratification of cardiovascular risk in patients with non-traumatic chest pain in the emergency department. Perspectives of the Heart Risk Score in patients with acute coronary syndrome.]

INTRODUCTION: Acute chest pain (CP) is a potentially related both to acute coronary syndrome and to other morbidities; this means that 2%-10% patients with cardiogenic CP are improperly discharged from the Emergency Room (ER). In order to identify risk to develop cardiovascular (CV) events in patients admitted to ER with CP, we used Heart Risk Score (HRS).MATERIALS AND METHODS: We included 165 patients referred to the ER for non-traumatic acute CP. We retrospectively analyzed clinical records from ER and Chest Pain Unit (CPU). We calculated HRS, then we analyzed HRS sensitivity and specificity, and correlated raw data of all variables with Spearman's analysis.RESULTS: Diagnosis of ischemic heart disease was made in 53.9% patients referring CP. The remaining patients were affected by other non-ischemic heart disease (35.5%), gastro-esophageal disease (32.3%), pleuro-pulmonary pathology (15.8%), musculoskeletal disorders (10.5%), and panic attacks (6.6%), respectively. Patients affected by coronaropathy had hypertension (80.9%), history of cardiopathy (61.8%), chronic smoking (49.4%), hypercholesterolemia (37.0%) , diabetes (33.7%) and obesity (24.7%). Low, medium and high HRS patients were 15.7%, 59.4% and 24.8%, respectively. Risk of CV events increased with the increase of the score. The negative predictive value (NPV) in low score was 92.3%. In high score, sensitivity and specificity were 94.7% and 82.7%, respectively. Finally, the following positive Spearman's correlations were found: HRS vs its risk variables, including individual risk variables, ischemic heart disease vs CV risk factors, history of ischemic cardiac disease vs risk factors, number of stenotic vessels vs risk factors (significance values: p <0.05).DISCUSSION: HRS contains history of all risk factors for coronary artery disease and considers mild ECG and troponin alterations, giving the possibility to undertake the most appropriate path for the patient.CONCLUSIONS: Our work evidences relevance, reliability and ease of use of HRS in CV risk stratification in the emergency department, giving an important contribution in the evaluation of individuals who are likely to experience ischemic heart disease

Presenza e caratterizzazione di Arcobacter spp. in ortaggi di IV gamma prodotti in Italia meridionale

Le informazioni disponibili in letteratura relative alla presenza di Arcobacter spp. negli alimenti di origine vegetale sono attualmente carenti. Ampiamente documentato è, tuttavia, il ruolo assunto da tali alimenti nel determinismo di malattie a trasmissione alimentare. Obiettivo del presente studio è, pertanto, acquisire dati relativi alla presenza di Arcobacter spp. negli ortaggi ready-to-eat (RTE), evidenziare specifici tratti di virulenza e genotipizzare gli isolati, per implementare e attuare una mirata valutazione e relativa gestione del rischio microbiologico. Nell'ambito del presente lavoro sono stati considerati ortaggi RTE e, specificatamente, 56 campioni di lattuga e 54 campioni di rucola, provenienti da uno stabilimento di ortaggi di IV gamma sito nella regione Puglia. Il percorso sperimentale ha previsto, inizialmente, l’isolamento colturale di Arcobacter spp., effettuato su terreno solido specifico. Le colonie, isolate come appartenenti presumibilmente ad Arcobacter spp., sono state, quindi, identificate tramite Multiplex-PCR e sequenziamento del gene rpob. Gli isolati, successivamente, sono stati caratterizzati in base alla presenza di specifici fattori di virulenza e, infine, genotipizzati mediante Multi-Locus Sequence Type (MLST). L’isolamento colturale ha rilevato la presenza di Arcobacter spp. in 16/110 (14.5 %) ortaggi RTE e, in particolar modo, in 11 campioni di lattuga e 5 campioni di rucola. Dall'analisi biomolecolare effettuata sui 16 isolati, 15 sono risultati appartenere alla specie A. butzleri e 1 alla specie A. cryaerophilus. Sono stati inoltre rilevati specifici tratti di patogenicità diversamente distribuiti nei 16 isolati. La genotipizzazione eseguita mediante MLST ha evidenziato la presenza di soltanto 6 Sequence Type (STs) e, quindi, una esigua variabilità genetica, attribuibile probabilmente all'origine univoca dei campioni considerati. Lo studio conferma la presenza di Arcobacter spp. negli ortaggi RTE, imputabile principalmente alla contaminazione della materia prima e sollecita l’applicazione di appropriate e corrette pratiche agronomiche. L’impiego di fertilizzanti, quali letame e liquame non correttamente trattati, infatti, è la principale causa di contaminazione microbiologica dei vegetali. Inoltre l'individuazione di specifici fattori di virulenza e la genotipizzazione molecolare di A. butzleri e A. cryaerophilus, possibili responsabili di gastroenterite ad eziologia ignota, evidenziano la necessità di introdurre un sistema di sorveglianza basato sulla caratterizzazione biomolecolare per una integrata valutazione del rischio microbiologico degli ortaggi RTE, per implementare un innovativo controllo della filiera e, conseguentemente, degli alimenti composti

Occurrence and characterization of Arcobacter spp. from ready-to-eat vegetables produced in Southern Italy

Given that the number of foodborne illness outbreaks linked to the consumption of ready-to-eat vegetables has been widely documented and considering that data on the occurrence of Arcobacter spp. in such foodstuffs are lacking, the aim of the present study was to evaluate the presence of Arcobacter spp. and the occurrence of virulence factors as well as to genotype Arcobacter spp. in ready-to-eat (RTE) vegetable samples, using cultural and biomolecular assays. Arcobacter spp. was detected in 16/110 (14.5%) samples, with A. butzleri being detected in 15/16 and A. cryaerophilus in 1/16 isolates. PCRs aimed at the nine putative virulence genes demonstrated widespread distribution of such genes among A. butzleri and A. cryaerophilus isolates. In addition, multilocus sequence type (MLST) analysis revealed a low genetic diversity within the arcobacters isolates. The results underline the need to develop an appropriate surveillance system based on biomolecular characterization for an integrated microbiological risk assessment of ready-toeat vegetables, and consequently of composite foods

Xanthoma of rib: a case report and review of the literature

Background: Xanthomas are well-circumscribed benign proliferative lesions seen mainly in soft tissues. Usually, they are found in hyperlipidemia and familial hyperlipoproteinemia. Histologically, are characterized by macrophage-like mononuclear cells, multinucleated giant cells and abundant foam cells. The bone involvement, however, is notoriously rare and rib localization is extremely rare. Case presentation: A 55-year-old man performed a chest X-ray and a subsequent chest Computed Tomography scan showing a rib lesion that was surgically removed and a diagnosis of rib xanthoma was made. The patient presented an unknown condition of hyperlipidemia. Conclusion: Rib xanthoma can be discovered accidentally and can be helpful in identifying an unrecognized condition of hyperlipidemia

Methylglyoxal (MGO) in Italian Honey

Methylglyoxal (MGO) is recognized as being the bioactive component responsible for the antibacterial activity of mānuka honey. MGO content was investigated by high-performance liquid chromatography (HPLC-UV), in isocratic elution, to assess the occurrence of this compound in mono- and multi-floral honey samples representative of different botanical and geographic origins in Italy. Specifically, 110 honey samples from sweet cherry tree (Prunus avium L.), thyme (Thymus vulgaris L.), almond tree (Prunus amygdalus L.), eucalyptus (Eucalyptus camaldulensis L.), coriander (Coriandrum sativum L.), cornflower (Centaurea cyanus L.), thistle (Silybum marianum L.), acacia (Robinia pseudoacacia L.), citrus, honeydew and multifloral honey were considered. The amount of MGO found in different types of honey was ranging from 0.4 to 24.1 mg/kg. This study provides, for the first time, data on MGO levels in Italian cherry and almond honey, which showed higher concentrations of MGO compared to honeys from other botanical species

Methylglyoxal (MGO) in Italian Honey

Methylglyoxal (MGO) is recognized as being the bioactive component responsible for the antibacterial activity of mānuka honey. MGO content was investigated by high-performance liquid chromatography (HPLC-UV), in isocratic elution, to assess the occurrence of this compound in mono- and multi-floral honey samples representative of different botanical and geographic origins in Italy. Specifically, 110 honey samples from sweet cherry tree (Prunus avium L.), thyme (Thymus vulgaris L.), almond tree (Prunus amygdalus L.), eucalyptus (Eucalyptus camaldulensis L.), coriander (Coriandrum sativum L.), cornflower (Centaurea cyanus L.), thistle (Silybum marianum L.), acacia (Robinia pseudoacacia L.), citrus, honeydew and multifloral honey were considered. The amount of MGO found in different types of honey was ranging from 0.4 to 24.1 mg/kg. This study provides, for the first time, data on MGO levels in Italian cherry and almond honey, which showed higher concentrations of MGO compared to honeys from other botanical species

Coaxial Drainage versus Standard Chest Tube after Pulmonary Lobectomy: A Randomized Controlled Study

Chest tubes are routinely inserted after thoracic surgery procedures in different sizes and numbers. The aim of this study is to assess the efficacy of Smart Drain Coaxial drainage compared with two standard chest tubes in patients undergoing thoracotomy for pulmonary lobectomy. Ninety-eight patients (57 males and 41 females, mean age 68.3 ± 7.4 years) with lung cancer undergoing open pulmonary lobectomy were randomized in two groups: 50 received one upper 28-Fr and one lower 32-Fr standard chest tube (ST group) and 48 received one 28-Fr Smart Drain Coaxial tube (SDC group). Hospitalization, quantity of fluid output, air leaks, radiograph findings, pain control and costs were assessed. SDC group showed shorter hospitalization (7.3 vs. 6.1 days, p = 0.02), lower pain in postoperative day-1 (p = 0.02) and a lower use of analgesic drugs (p = 0.04). Pleural effusion drainage was lower in SDC group in the first postoperative day (median 400.0 ± 200.0 mL vs. 450.0 ± 193.8 mL, p = 0.04) and as a mean of first three PODs (median 325.0 ± 137.5 mL vs. 362.5 ± 96.7 mL, p = 0.01). No difference in terms of fluid retention, residual pleural space, subcutaneous emphysema and complications after chest tubes removal was found. In conclusion, Smart Drain Coaxial chest tube seems a feasible option after thoracotomy for pulmonary lobectomy. The SDC group showed a shorter hospitalization and decreased analgesic drugs use and, thus, a reduction of costs