Kidney transplantation with presymptomatic COVID-19–positive surgeon

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An audit of TB prevention on Italian health care workers

Tuberculosis (TB) is considered an occupational disease in health care workers. The aim of this study is to asses the state of tuberculosis prevention among the personnel of the Vaccina- tion Services of the Puglia Region (Italy), who were given an interview-based standardised questionnaire. Of the 302 replies, TB screening had been undergone by 80.5%, whom 78.6% took advice by the occupational health physician. Of those who were negative to the PPD skin test, 60.6% had received BCG, whom 78% took vaccination advice by the occupational health physi- cian. In Italy, the procedures for the monitoring and prevention of tuberculosis are a consolidated practice for occupational health physicians

Thin walled pottery from Alife (Northern Campania, Italy)

The file attached is the published version of the article

Normothermic and hypothermic oxygenated perfusion for donation after circulatory death in kidney transplantation: Do we pay higher risk of severe infection after transplantation?: A case report

Background: Normothermic and hypothermic oxygenated perfusion for donation after circulatory death in kidney transplantation are becoming popular in Italy, with the purpose of reducing the risk of primary non function and delayed graft function due to the prolonged warm ischemia time. Potential complications related to these procedures are currently under investigation and are continuously emerging with the increasing experience. Post-operative infections - in particular graft arteritis - are a rare complication but determine high risk of mortality and of graft loss. The acute onset of the arterial complications makes it very difficult to find an effective treatment, and early diagnosis is crucial for saving both patient and graft. Prevention of such infections in this particular setting are advisable. Case presentation: We present a patient with an acute arterial rupture after transplantation of a DCD graft treated in-vivo hypothermic oxygenated perfusion. The cause was a severe arteritis of the renal artery caused by Candida krusei and Pseudomonas aeruginosa. We discussed our treatment and we compared it to the other reported series. Conclusion: Fungal infections in DCD transplant may be treacherous and strategies to prevent them should be advocated

Malignant cancer mortality in Province of Taranto (Italy). Geographic analysis in an area of high environmental risk

Background. A geographic analysis of the causes of death is an important tool for assessing the effectiveness of Public Health initiatives. The aim of this study is to analyse the causes of death between 2000 and 2004, to discover any excess mortality from can- cer in Province of Taranto, an area at high environmental risk. Methods. Mortality data from cancer were selected from the Puglia Regional Nominative Causes of Death Registry. Crude and standardized rates and Standardized Mortality Ratios (SMR) were calculated for the five Provinces of the Puglia Region, their capital cities and in four concentric rings around the industrial area located in Province of Taranto. Results. Even if the highest death rate for all tumours resulted in the Province of Lecce (24.9 x 10,000), in the cities of Lecce and Bari (29 x 10,000), the distribution of the SMRs in Province of Taranto showed an excess of mortality (+10%) in the ring next to industrial area. For lung cancer the highest rate was reported in city of Taranto (6 x10,000) and the highest risk (+24%) in the ring next to industrial area. Moreover, in this area 9 (70%) of the 13 considered malignant tumours types presented an excess of mortality. Conclusion. The results uphold the data reported in the pub- lished literature. It is fundamental to intensify research into other risk factors (exposure at work and aberrant lifestyles). Moreover, there is an increasing need for a Regional Cancer Register

Hospital discharges-based search of acute flaccid paralysis cases 2007-2016 in Italy and comparison with the National Surveillance System for monitoring the risk of polio reintroduction

Background: Acute flaccid paralysis (AFP) surveillance has been adopted globally as a key strategy for monitoring the progress of the polio eradication initiative. Hereby, to evaluate the completeness of the ascertainment of AFP cases in Italy, a hospital-discharges based search was carried out. Methods: AFP cases occurring between 2007 and 2016 among children under 15 years of age were searched in the Italian Hospital Discharge Records (HDR) database using specific ICD-9-CM diagnostic codes. AFP cases identified between 2015 and 2016 were then compared with those notified to the National Surveillance System (NSS). Results: Over a 10-year period, 4163 hospital discharges with diagnosis of AFP were reported in Italy. Among these, 956 (23.0%) were acute infective polyneuritis, 1803 (43.3%) myopathy, and 1408 (33.8%) encephalitis, myelitis and encephalomyelitis. During the study period, a decreasing trend was observed for all diagnoses and overall the annual incidence rate (IR) declined from 5.5 to 4.5 per 100,000 children. Comparing NSS with HDR data in 2015-2016, we found a remarkable underreporting, being AFP cases from NSS only 14% of those recorded in HDR. In particular, the acute infective polyneuritis cases reported to NSS accounted for 42.6% of those detected in HDR, while only 0.9% of myopathy cases and 13.1% of encephalitis/myelitis/encephalomyelitis cases have been notified to NSS. The highest AFP IRs per 100,000 children calculated on HDR data were identified in Liguria (17.4), Sicily (5.7), and Veneto (5.1) Regions; regarding the AFP notified to the NSS, 11 out of 21 Regions failed to reach the number of expected cases (based on 1/100,000 rate), and the highest discrepancies were observed in the Northern Regions. Overall, the national AFP rate was equal to 0.6, therefore did not reach the target value. Conclusions: AFP surveillance data are the final measure of a country's progress towards polio eradication. The historical data obtained by the HDR have been useful to assess the completeness of the notification data and to identify the Regions with a low AFP ascertainment rate in order to improve the national surveillance system

On the energy functional on Finsler manifolds and applications to stationary spacetimes

In this paper we first study some global properties of the energy functional on a non-reversible Finsler manifold. In particular we present a fully detailed proof of the Palais--Smale condition under the completeness of the Finsler metric. Moreover we define a Finsler metric of Randers type, which we call Fermat metric, associated to a conformally standard stationary spacetime. We shall study the influence of the Fermat metric on the causal properties of the spacetime, mainly the global hyperbolicity. Moreover we study the relations between the energy functional of the Fermat metric and the Fermat principle for the light rays in the spacetime. This allows us to obtain existence and multiplicity results for light rays, using the Finsler theory. Finally the case of timelike geodesics with fixed energy is considered.Comment: 23 pages, AMSLaTeX. v4 matches the published versio

Hypothermic Oxygenated New Machine Perfusion System in Liver and Kidney Transplantation of Extended Criteria Donors:First Italian Clinical Trial

With the aim to explore innovative tools for organ preservation, especially in marginal organs, we hereby describe a clinical trial of ex-vivo hypothermic oxygenated perfusion (HOPE) in the field of liver (LT) and kidney transplantation (KT) from Extended Criteria Donors (ECD) after brain death. A matched-case analysis of donor and recipient variables was developed: 10 HOPE-ECD livers and kidneys (HOPE-L and HOPE-K) were matched 1:3 with livers and kidneys preserved with static cold storage (SCS-L and SCS-K). HOPE and SCS groups resulted with similar basal characteristics, both for recipients and donors. Cumulative liver and kidney graft dysfunction were 10% (HOPE L-K) vs. 31.7%, in SCS group (p = 0.05). Primary non-function was 3.3% for SCS-L vs. 0% for HOPE-L. No primary non-function was reported in HOPE-K and SCS-K. Median peak aspartate aminotransferase within 7-days post-LT was significantly higher in SCS-L when compared to HOPE-L (637 vs.344 U/L, p = 0.007). Graft survival at 1-year post-transplant was 93.3% for SCS-L vs. 100% of HOPE-L and 90% for SCS-K vs. 100% of HOPE-K. Clinical outcomes support our hypothesis of machine perfusion being a safe and effective system to reduce ischemic preservation injuries in KT and in LT