A rare case of necrotizing fasciitis of the leg in an intravenous drug user caused by Prevotella denticola

Background: Intravenous drug users (IDUs) have a high risk of developing skin and soft tissue infections such as erysipelas, abscesses, and less frequently necrotizing fasciitis (NF) or gas gangrene. Rarely, the cause of the infection is microorganisms residing in the oral cavity and can lead to life-threatening infections. Methods: We describe the case of a 43-year-old man intravenous drug user (IDU) who was admitted for intense leg pain following an injection of cocaine at that site. Results: A clinical and radiological diagnosis of NF was made, so the patient was started on empirical antibiotic therapy and underwent surgical fasciotomy (after 8 hours from admission). Prevotella denticola was isolated from multiple intraoperative specimens and was resistant to initial antimicrobial therapy. The man, suffering from periodontal disease, reported sucking the syringe several times to unblock it. Both fasciotomy surgery and adjustment of antimicrobial therapy enabled therapeutic success. Conclusions: In IDUs the risk of deep skin and soft tissue infections is high and may be aggravated by contamination with oral microorganisms. The choice of empirical antibiotic treatment should include agents active against oral cavity anaerobes, such as P. denticola

Reinventing the Adult Education Curriculum within an Urban Latino Community

This paper will examine an adult education Masters program developed in collaboration with an urban Latino community. Its pedagogy and its content are described in the voices of students reflecting on how they have applied their new understandings and research skills to social change initiatives within the community

Fonderia Caratteri Nebiolo, 1878–1978. Nuovi studi critici

La Società Nebiolo di Torino è stata la più importante fonderia italiana di caratteri da stampa a livello nazionale e internazionale per gran parte del Novecento, fino alla sua chiusura avvenuta nel 1978. Nata da una piccola fonderia aperta nel 1852 e rilevata da Giovanni Nebiolo nel 1878, la Nebiolo venne ufficialmente costituita nel 1880. Una rapida espansione commerciale la porterà, entro la fine dell’Ottocento, a sviluppare con successo la produzione di macchine da stampa, settore nel quale dominerà il mercato italiano fino agli anni Settanta del secolo scorso. Nebiolo è ricordata soprattutto per il suo contributo nel campo dei caratteri da stampa. Lo Studio artistico – guidato in successione da Giulio Da Milano, Alessandro Butti e Aldo Novarese – ha progettato caratteri importanti che hanno segnato la storia della grafica italiana e non solo. A causa della dispersione degli archivi dell’azienda, è mancata finora una valutazione critica del suo patrimonio storico. Attraverso questo primo convegno internazionale e la pubblicazione dei suoi atti, il Nebiolo History Project offre finalmente un’ampia panoramica delle ricerche più aggiornate su aspetti finora poco indagati riguardanti la Società Nebiolo e il suo ruolo nella storia industriale e delle arti grafiche in Italia

Valorization of traditional Italian walnut (Juglans regia L.) production: genetic, nutritional and sensory characterization of locally grown varieties in the Trentino region

15openYesJuglans regia (L.) is cultivated worldwide for its nutrient-rich nuts. In Italy, despite the growing demand, walnut cultivation has gone through a strong decline in recent decades, which led to Italy being among the top five net importing countries. To promote the development of local high-quality Italian walnut production, we devised a multidisciplinary project to highlight the distinctive traits of three varieties grown in the mountainous region Trentino (northeast of Italy): the heirloom ‘Bleggiana’, a second local accession called local Franquette and the French cultivar ‘Lara’, recently introduced in the local production to increase yield. The genetic characterization confirmed the uniqueness of ‘Bleggiana’ and revealed local Franquette as a newly described autochthonous variety, thus named ‘Blegette’. The metabolic profiles highlighted a valuable nutritional composition of the local varieties, richer in polyphenols and with a lower ω-6/ω-3 ratio than the commercial ‘Lara’. ‘Blegette’ obtained the highest preference scores from consumers for both the visual aspect and tasting; however, the volatile organic compound profiles did not discriminate among the characterized cultivars. The described local varieties represent an interesting reservoir of walnut genetic diversity and quality properties, which deserve future investigation on agronomically useful traits (e.g., local adaptation and water usage) for a high-quality and sustainable production.Di Pierro, Erica A.; Franceschi, Pietro; Endrizzi, Isabella; Farneti, Brian; Poles, Lara; Masuero, Domenico; Khomenko, Iuliia; Trenti, Francesco; Marrano, Annarita; Vrhovsek, Urska; Gasperi, Flavia; Biasioli, Franco; Guella, Graziano; Bianco, Luca; Troggio, MichelaDi Pierro, E.A.; Franceschi, P.; Endrizzi, I.; Farneti, B.; Poles, L.; Masuero, D.; Khomenko, I.; Trenti, F.; Marrano, A.; Vrhovsek, U.; Gasperi, F.; Biasioli, F.; Guella, G.; Bianco, L.; Troggio, M

Quality of life and intrinsic capacity in patients with post-acute COVID-19 syndrome is in relation to frailty and resilience phenotypes.

Background- The objective of this study was to characterize frailty and resilience in people evaluated for Post-Acute COVID-19 Syndrome (PACS), in relation to quality of life (QoL) and Intrinsic Capacity (IC). Methods- This cross-sectional, observational, study included consecutive people previously hospitalized for severe COVID-19 pneumonia attending Modena (Italy) PACS Clinic from July 2020 to April 2021. Four frailty-resilience phenotypes were built: “fit/resilient”, “fit/non-resilient”, “frail/resilient” and “frail/non-resilient”. Frailty and resilience were defined according to frailty phenotype and Connor Davidson resilience scale (CD-RISC-25) respectively. Study outcomes were: QoL assessed by means of Symptoms Short form health survey (SF-36) and health-related quality of life (EQ-5D-5L) and IC by means of a dedicated questionnaire. Their predictors including frailty-resilience phenotypes were explored in logistic regressions. Results- 232 patients were evaluated, median age was 58.0 years. PACS was diagnosed in 173 (74.6%) patients. Scarce resilience was documented in 114 (49.1%) and frailty in 72 (31.0%) individuals. Predictors for SF-36 score <61.60 were the phenotypes “frail/non-resilient” (OR=4.69, CI:2.08-10.55), “fit/non-resilient” (OR=2.79, CI:1.00-7.73). Predictors for EQ-5D-5L <89.7% were the phenotypes “frail/non-resilient” (OR=5.93, CI: 2.64-13.33) and “frail/resilient” (OR=5.66, CI:1.93-16.54). Predictors of impaired IC (below the mean score value) were “frail/non-resilient” (OR=7.39, CI:3.20-17.07), and “fit/non-resilient” (OR=4.34, CI:2.16-8.71) phenotypes. Conclusions- Resilience is complementary to frailty in the identification of clinical phenotypes with different impact on wellness and QoL. Frailty and resilience should be evaluated in hospitalized COVID-19 patients to identify vulnerable individuals to prioritize urgent health interventions in people with PACS

COVID-19-associated vasculitis and thrombotic complications: from pathological findings to multidisciplinary discussion

Neutrophilic arterial vasculitis in COVID-19 represents a novel finding and could be responsible for thrombotic complications

Do all critically ill patients with COVID-19 disease benefit from adding tocilizumab to glucocorticoids? A retrospective cohort study.

Background: Treatment guidelines recommend the tocilizumab use in patients with a CRP of >7.5 mg/dL. We aimed to estimate the causal effect of glucocorticoids + tocilizumab on mortality overall and after stratification for PaO2/FiO2 ratio and CRP levels. Methods: This was an observational cohort study of patients with severe COVID-19 pneumonia. The primary endpoint was day 28 mortality. Survival analysis was conducted to estimate the conditional and average causal effect of glucocorticoids + tocilizumab vs. glucocorticoids alone using Kaplan–Meier curves and Cox regression models with a time-varying variable for the intervention. The hypothesis of the existence of effect measure modification by CRP and PaO2/FiO2 ratio was tested by including an interaction term in the model. Results: In total, 992 patients, median age 69 years, 72.9% males, 597 (60.2%) treated with monotherapy, and 395 (31.8%), adding tocilizumab upon respiratory deterioration, were included. At BL, the two groups differed for median values of CRP (6 vs. 7 mg/dL; p 7.5 mg/dL prior to treatment initiation and the largest effect for a CRP > 15 mg/dL. Large randomized studies are needed to establish an exact cut-off for clinical use

Post-exercise high-sensitivity troponin T levels in patients with suspected unstable angina

Background Previous studies showed that troponin blood levels may increase after exercise. In this study we assessed whether, among patients admitted with suspected unstable angina, the increase in high-sensitive troponin T (hs-TnT) levels after exercise stress test (EST) might help identify those with obstructive coronary artery disease (CAD) and predict symptom recurrence during short term follow-up. Methods Maximal treadmill EST was performed in 69 consecutive patients admitted to the emergency room with a suspicion of unstable angina (acute chest pain but confirmed normal serum levels of cardiac troponins) was measured before and 4 hours after EST. Coronary angiography was performed in 22 patients (32.8%). Results hs-TnT increased after EST compared to baseline in the whole population (from 0.84\ub10.65 to 1.17\ub10.87 ng/dL, p<0.001). The increase was similar in patients with positive (n = 14) and negative (n = 55) EST (p = 0.72), and was also similar in patients with (n = 12) and without (n = 10) obstructive CAD at angiography (p = 0.91). The achievement of a heart rate at peak EST \ufffd85% of that predicted for age was the variable mainly associated with the post- EST hs-TnT increase at multivariable linear regression analysis (p = 0.005). The change after EST of hs-TnT did not predict the recurrence of symptoms or readmission for chest pain at 6-month follow-up. Conclusions Our data show that hs-TnT increased after EST in patients with suspected unstable angina, which seemed largely independent of most clinical and laboratory variables. Thus, hs-TnT assessed after EST does not seem to be helpful to identify patients with obstructive CAD in this kind of patients

Leucemia mieloide Crónica

La LMC es una enfermedad que afecta a las células madre hematopoyéticas. Se caracteriza por la presencia del cromosoma Ph, que resulta de la translocación recíproca entre los cromosomas 9 y 22 [t(9;22) (q34;q11)], y genera la yuxtaposición de los genes BCR y ABL1 dando origen a una proteína oncogénicacon actividad de tirosina kinasa incrementada, alterando las vías de proliferación y supervivencia. Según el punto de ruptura de los genes BCR y ABL1, se generan distintos rearreglos (b2a2 o b3a2, e1a2 y e19a2 ), dando lugar a proteínas de distintos pesos moleculares (P210, P190, P230). En la mayoría de las LMC, se puede detectar el transcripto de la isoforma P210, pero se han descripto casos con P190, P230 u otras con menor frecuencia. El mejor conocimiento de la biología de la enfermedad y la descripción de los mecanismos de resistencia, permitió el desarrollo de tratamientos blanco-moleculares como ITK, logrando una ventaja significativa en la sobrevida de estos pacientes, dada la gran efectividad en la inactivación de la proteína oncogénica.De esta manera, la introducción del imatinib, generó un cambio en el seguimiento de la LMC. La necesidad de mejorar su eficacia y optimizar el manejo de los pacientes llevó al desarrollo de nuevas formulaciones dentro de los ITKs, dasatinib, nilotinib, ponatinib y bosutinib*. La evolución de las técnicas genéticas y moleculares también permitió mejorar el monitoreo de esta enfermedad. La evaluación de la carga tumoral a través de la cuantificación de transcriptos BCR-ABL1 y su actual posibilidad de detectar hasta 4.5 log de reducción de los mismos, así como la posibilidad de evaluar los mecanismos de resistencia con la detección de mutaciones del gen translocado y la descripción de nuevos potenciales sitios de acción, nos muestran que estamos una vez más en un proceso de constante progreso en el manejo de esta patología. Diversas instituciones y grupos de trabajo en el mundo, como ELN, NCCN, NICE, ESMO, han desarrollado recomendaciones para el manejo de la LMC, logrando generar pautas homogéneas, tanto diagnósticas como terapéuticas y de monitoreo.Fil: Beligoy, Luis. No especifíca;Fil: Bendek del Prete, Georgina Emilia. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Bengió, Raquel. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex"; ArgentinaFil: Bullorsky, Laura. Hospital Británico de Buenos Aires; ArgentinaFil: Enrico, Alicia. Hospital Italiano de La Plata; ArgentinaFil: Franceschi, Erica. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; ArgentinaFil: Larripa, Irene Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Moiraghi, Beatriz. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Osycka, Victoria. No especifíca;Fil: Riveros, Dardo Alberto. No especifíca;Fil: Rojas, Francisca. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Varela, Ana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Ventriglia, Verónica. No especifíca