Post-surgical Thyroid Bed Pyoderma Gangrenosum Mimicking Recurrent Papillary Thyroid Carcinoma

Background: Pyoderma gangrenosum (PG) is a rare inflammatory disease presenting with chronic-recurrent cutaneous ulcers histopathologically hallmarked by neutrophilic infiltrates, which may occur more frequently at sites of surgical traumas. The disease is habitually limited to the skin, but it can virtually involve any organ. Nevertheless, no prior cases of PG involving the thyroid bed have ever been reported.Case Report: A bilateral PG of the breast was diagnosed in a 51-year-old woman and treated with intravenous methylprednisolone pulse-therapy and cyclosporine, with partial improvement. During the hospitalization, cytological examination of two hypoechoic thyroid nodules by fine-needle aspiration (FNA) was consistent with thyroid carcinoma. After total thyroidectomy, histopathology confirmed a papillary thyroid cancer (PTC), and radioactive iodine ablation was performed. At 12-month ultrasonographic follow-up, two hypoechoic avascular areas localized in the empty thyroid bed raised the suspect of PTC recurrence. However, (i) undetectable levels of thyroglobulin without anti-thyroglobulin antibodies, (ii) neutrophilia and increased inflammatory marker levels, and (iii) cytological examination of FNA showing numerous neutrophils induced to suspect thyroid bed PG infiltration. An ex juvantibus approach with high-dose methylprednisolone led to dimensional reduction of the hypoechoic areas on ultrasonography, thus confirming the hypothesis of thyroid bed PG.Conclusion: This case of thyroid bed PG supports the idea that PG reflects a cutaneous phenotype encompassed in the spectrum of systemic neutrophilic diseases. Endocrinologists should be aware that thyroid bed PG involvement is an albeit rare differential diagnosis to consider in patients who had undergone thyroid surgery, especially with a history of PG

An observational study on the effects of early and late risk factors on the development of childhood obesity in the South of Italy

Background: Child obesity is today one of the greatest health emergencies, on such a large scale as to be considered a global epidemic by the WHO and, unfortunately, Italy holds the worst European record. Methods: We conducted an observational study to investigate the effects of early and late risk factors on the development of primary childhood obesity. We collected anthropometric parameters, information about early risk markers and late risk factors on a sample of 280 children from March 2016 to December 2017. Results: Statistically significant associations emerged between: child's BMI and education level of the mother (p<0.001) and the father (p<0.05); level of parents' education and qualitative variables (subjects’ physical activity level (p<0.05), consumption of carbonated beverages (p<0.05), fruit juices (p <0.05) and snacks (p<0.05); BMI and the presence or absence of a family history of obesity, DM and cardiovascular diseases. Significant linear correlations were found between weight classification (overweight/obese) and the consumption of carbonated drinks (p<0.05), snack consumption (p<0.05), physical activity levels (p<0.001) and duration of sleep in the afternoon (p<0.05). Conclusions: In our sample we found incorrect eating habits to be frequently linked to a low level of parental education; particularly for the mother, the main childcare provider

FIVE-YEAR MICROBIOLOGICAL MONITORING OF WARDS AND OPERATING THEATRES IN SOUTHERN ITALY

INTRODUCTION. Nosocomial infections are one of the greatest problems in public health. Several studies have highlighted the role played by the hospital environment as a possible source of transmission of nosocomial pathogens.METHODS. A five-year monitoring of bacterial contamination on healthcare workers hands, surfaces most closely in contact with inpatient wards, operating theatres and “at rest” and “in use” operating theatre air samples. For the samples, we used sterile swabs, contact slides, manual API, and automated VITEK systems for identification.RESULTS. In the five-year period, a total of 9396 samples were collected and analysed. In ward patients, 4398 samplings were carried out with 4.7%, 9.4%, 7%, 10.8% and 7.9% positive results respectively from 2010 to 2014. For hands, 648 samplings were carried out, with a positivity of 40.74%. In operating theatres, 4188 samples were taken, with a positivity of 11.9%. Regarding air in empty and full theatres, 1962 samplings were carried out with a positivity rate equal to 31.9%. The monitoring showed a low rate of contamination with a progressive decrease in the five-year period on operating theatres surfaces and hands, while there was an increase in the surgical site wards and in the air of operating rooms.CONCLUSIONS. Our investigation has revealed the presence of pathogens on the assessed surfaces and the need for environmental monitoring, which can be a valuable tool for reducing contamination

An evaluation of gambling addiction and video lottery in the South of Italy

Nowadays, pathological gambling is an emerging health problem. The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) renames it as 'Gambling Disorder' (GD), thus recognising its highly dependent status. A study was conducted from April 2016 to August 2017 to evaluate the prevalence of this phenomenon by administering an ad hoc questionnaire to adult individuals (both sexes) over the age of 18.  We analysed a sample of 562 individuals with DSM 5 criteria. We obtained a score > 4 indicating a possible mild gambling disorder in 1.6% of the sample and a score > 6 corresponding to a moderate GD in 2.3% of the sample. We observed that the main motivations for gambling were “having fun” and “the prospect of winning” and 10.9% of respondents had played more than they intended. Furthermore, "problematic" players showed to be more prone to alcohol abuse than "social" players (p < 0.001). Only 7.5% of respondents had already gambling problems in their family (involving in particular their mothers). The phenomenon is, therefore, quite common in our area and, indeed, 64.1% of the sample believes that gambling is a problem in their own territory, however only 20.6% would know where to find help. In conclusion, given the high socio-economic impact of this phenomenon, we believe that it is imperative to establish structured preventions programs in order to to contain the spread of this phenomenon.  Key words

N-Glycomic changes in serum proteins in type 2 diabetes mellitus correlate with complications and with metabolic syndrome parameters

Background: Glycosylation, i.e the enzymatic addition of oligosaccharides (or glycans) to proteins and lipids, known as glycosylation, is one of the most common co-/posttranslational modifications of proteins. Many important biological roles of glycoproteins are modulated by N-linked oligosaccharides. As glucose levels can affect the pathways leading to glycosylation of proteins, we investigated whether metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM), pathological conditions characterized by altered glucose levels, are associated with specific modifications in serum N-glycome. Methods: We enrolled in the study 562 patients with Type 2 Diabetes Mellitus (T2DM) (mean age 65.6 +/- 8.2 years) and 599 healthy control subjects (CTRs) (mean age, 58.5 +/- 12.4 years). N-glycome was evaluated in serum glycoproteins. Results: We found significant changes in N-glycan composition in the sera of T2DM patients. In particular, alpha(1,6)-linked arm monogalactosylated, core-fucosylated diantennary N-glycans (NG1(6)A2F) were significantly reduced in T2DM compared with CTR subjects. Importantly, they were equally reduced in diabetic patients with and without complications (P<0.001) compared with CTRs. Macro vascular-complications were found to be related with decreased levels of NG1(6) A2F. In addition, NG1(6) A2F and NG1(3) A2F, identifying, respectively, monogalactosylated N-glycans with alpha(1,6)- and alpha(1,3)-antennary galactosylation, resulted strongly correlated with most MS parameters. The plasmatic levels of these two glycans were lower in T2DM as compared to healthy controls, and even lower in patients with complications and MS, that is the extreme "unhealthy" phenotype (T2DM+ with MS). Conclusions: Imbalance of glycosyltransferases, glycosidases and sugar nucleotide donor levels is able to cause the structural changes evidenced by our findings. Serum N-glycan profiles are thus sensitive to the presence of diabetes and MS. Serum N-glycan levels could therefore provide a non-invasive alternative marker for T2DM and MS

Impacts of Europe's Changing Climate - 2008 Indicator Based Assessment

Background and objective This report is an update and extension of the 2004 EEA report 'Impacts of Europe's changing climate'. Since 2004, there has been much progress in monitoring and assessing the impacts of climate change in Europe. The objectives of this report are to present this new information on past and projected climate change and its impacts through indicators, to identify the sectors and regions most vulnerable to climate change with a need for adaptation, and to highlight the need to enhance monitoring and reduce uncertainties in climate and impact modelling. To reflect the broadening of coverage of indicators and make use of the best available expertise, the report has been developed jointly by EEA, JRC and WHO Regional Office for Europe. Global developments in science and policy The Intergovernmental Panel on Climate Change (IPCC) in its 4th Assessment report reconfirmed and strengthened earlier scientific findings about key aspects of climate change. Increased monitoring and research efforts have enhanced understanding of climate change impacts and vulnerability. At the 2007 Bali climate change conference, the urgency of responding effectively to climate change through both adaptation and mitigation activities was recognised by a larger number of countries than ever before. The EU has proposed a target of a maximum global temperature increase of 2 °C above the pre-industrial level. A post-Kyoto regime that would include both adaptation and mitigation is expected to be agreed by end of 2009. There has been progress in implementing the Nairobi work programme on impacts, vulnerability and adaptation to climate change, developed to help countries improve their understanding of climate change impacts. European developments in science and policy European research on impacts and vulnerability in the context of national programmes and the 5th and 6th Framework Programmes has advanced considerably, making a major contribution to international assessments such as those of the IPCC, the Arctic Impact Assessment, the UNEP Global Outlook for Ice and Snow and WHO reports. New research programmes focusing on impacts, vulnerability and adaptation are currently being developed in many member countries and in the context of the 7th Framework Programme. On the policy side, the European Commission published its Green Paper on adaptation in 2007, to be followed by a White Paper by the end of 2008 with concrete proposals for action. This report The main part of this report summarises the relevance, past trends and future projections for about 40 indicators (from 22 in the 2004 report). The indicators address atmosphere and climate, the cryosphere, marine systems, terrestrial systems and biodiversity, agriculture and forestry, soil, water quantity (including floods and droughts), water quality and fresh water ecology, and human health. After a brief introduction, several chapters deal in a general way with the changes in the climate system and the observed and projected impacts. The report ends with chapters on adaptation and the economics of climate change impacts and adaptation strategies and policies, and data availability and uncertainty.JRC.H.7-Land management and natural hazard

Vaccination coverage in healthcare workers: a multicenter cross-sectional study in Italy

IntroductionIn recent years, a phenomenon known as "vaccine hesitancy" has spread throughout the world, even among health workers, determining a reduction in vaccination coverage (VC). A study aimed at evaluating VC among healthcare workers (HCWs) in 10 Italian cities (L'Aquila, Genoa, Milan, Palermo, Sassari, Catanzaro, Ferrara, Catania, Naples, Messina) was performed.Materials and methodsAnnex 3 of the Presidential Decree n. 445 of 28 December 2000 was used to collect information on the vaccination status of HCWs. The mean and standard deviation (SD) were calculated with regard to the quantitative variable (age), while absolute and relative frequencies were obtained for categorical data (sex, professional profile, working sector, vaccination status). The connection between VC and the categorical variables was evaluated by chi-square method (statistical significance at p&lt;0.05). The statistical analyses were performed by SPSS and Stata software.ResultsA total of 3,454 HCWs participated in the project: 1,236 males and 2,218 females. The sample comprised: physicians (26.9%), trainee physicians (16.1%), nurses (17.2%) and other professional categories (9.8%). Low VC was generally recorded. Higher VC was found with regard to polio, hepatitis B, tetanus and diphtheria, while coverage was very low for measles, mumps, rubella, pertussis, chickenpox and influenza (20-30%). ConclusionsThis study revealed low VC rates among HCWs for all the vaccinations. Measures to increase VC are therefore necessary in order to prevent HCWs from becoming a source of transmission of infections with high morbidity and/or mortality both within hospitals and outside

Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand

Objective: The aim of this study was to describe growth during puberty in young people with vertically acquired HIV. Design: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. Methods: One thousand and ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1-10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters. Results: At ART initiation, median age and HAZ was 6.4 [interquartile range (IQR): 2.8, 9.0] years and -1.2 (IQR: -2.3 to -0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20-0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21-1.78) years later in those starting with HAZ less than -3 compared with HAZ at least -1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than -1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least -1, there was no association with age. Girls and boys who initiated ART with HAZ at least -1 maintained a similar height to the WHO reference mean. Conclusion: Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least -1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age