First case of Mediterranean spotted fever-associated rhabdomyolysis leading to fatal acute renal failure and encephalitis

Mediterranean spotted fever (MSF) is a tick-borne zoonosis caused by Rickettsia conorii. In Italy, about 400 cases are reported every year and nearly half of them occur in Sicily, which is one of the most endemic regions. Although MSF is mostly a self-limited disease characterized by fever, skin rash, and a dark eschar at the site of the tick bite called a 'tache noire', serious complications are described, mainly in adult patients. Nevertheless, severe forms of the disease with major morbidity and a higher mortality risk have been described. We report a fatal case of MSF complicated by rhabdomyolysis, acute renal failure, and encephalitis in an elderly woman

Leprosy-like cutaneous presentation of Histoplasma capsulatum infection in an African HIV+ patient

Histoplasma capsulatum is an opportunistic dimorphic fungus responsible for most often self-limiting or flu-like infections but potentially lethal in immunocompromised hosts. Histoplasmosis is rare in Europe. We reported a case of disseminated histoplasmosis in an African HIV patient with a leprosy-like primary cutaneous presentation and involvement of lungs, brain, limphnodes and eye. The therapy with liposomial B amphotericin and itraconazole led to a prompt resolution of the symptoms

Prevalencia histórica de hábitos saludables, en mujeres de 50 a 70 años diagnosticadas con osteoporosis en las ciudades de San Martín y Junín de Mendoza

Se establece que las mujeres que hoy padecen osteoporosis y que tienen entre 50 a 70 años han tenido a lo largo de sus vidas una regular nutrición y un escaso nivel de práctica de ejercicio y/o actividad física. Se puede sugerir a partir de este estudio, en ámbitos educativos formales y no formales, que se genere entre niñas y mujeres jóvenes, la conciencia de los beneficios que se obtienen con un estilo de vida saludable, y de ser necesario, se puede sugerir realizar los ajustes a nivel curricular que apunten a mejorar su futura calidad de vida

A case of Brucella endocarditis in association with subclavian artery thrombosis

Brucellosis is a common zoonosis, endemic in Mediterranean countries, and caused by bacteria of Brucella genus. Brucellosis is a systemic infection and the clinical presentation varies widely from asymptomatic and mild to severe disease. Cardiovascular complications are extremely rare. We present a case of arterial thrombosis in a previously healthy young patient with Brucella endocarditis. Careful attention must be paid to any sign or symptom of thrombosis in patients affected by brucellosis, regardless of the presence of endocarditis and cardiovascular risk factors. PMID:22844622[PubMed] PMCID:PMC3400327Free PMC Articl

Randomized trial of conventional transseptal needle versus radiofrequency energy needle puncture for left atrial access (the TRAVERSE-LA study).

BackgroundTransseptal puncture is a critical step in achieving left atrial (LA) access for a variety of cardiac procedures. Although the mechanical Brockenbrough needle has historically been used for this procedure, a needle employing radiofrequency (RF) energy has more recently been approved for clinical use. We sought to investigate the comparative effectiveness of an RF versus conventional needle for transseptal LA access.Methods and resultsIn this prospective, single-blinded, controlled trial, 72 patients were randomized in a 1:1 fashion to an RF versus conventional (BRK-1) transseptal needle. In an intention-to-treat analysis, the primary outcome was time required for transseptal LA access. Secondary outcomes included failure of the assigned needle, visible plastic dilator shavings from needle introduction, and any procedural complication. The median transseptal puncture time was 68% shorter using the RF needle compared with the conventional needle (2.3 minutes [interquartile range {IQR}, 1.7 to 3.8 minutes] versus 7.3 minutes [IQR, 2.7 to 14.1 minutes], P = 0.005). Failure to achieve transseptal LA access with the assigned needle was less common using the RF versus conventional needle (0/36 [0%] versus 10/36 [27.8%], P < 0.001). Plastic shavings were grossly visible after needle advancement through the dilator and sheath in 0 (0%) RF needle cases and 12 (33.3%) conventional needle cases (P < 0.001). There were no differences in procedural complications (1/36 [2.8%] versus 1/36 [2.8%]).ConclusionsUse of an RF needle resulted in shorter time to transseptal LA access, less failure in achieving transseptal LA access, and fewer visible plastic shavings

Baseline characteristics of patients in the reduction of events with darbepoetin alfa in heart failure trial (RED-HF)

<p>Aims: This report describes the baseline characteristics of patients in the Reduction of Events with Darbepoetin alfa in Heart Failure trial (RED-HF) which is testing the hypothesis that anaemia correction with darbepoetin alfa will reduce the composite endpoint of death from any cause or hospital admission for worsening heart failure, and improve other outcomes.</p> <p>Methods and results: Key demographic, clinical, and laboratory findings, along with baseline treatment, are reported and compared with those of patients in other recent clinical trials in heart failure. Compared with other recent trials, RED-HF enrolled more elderly [mean age 70 (SD 11.4) years], female (41%), and black (9%) patients. RED-HF patients more often had diabetes (46%) and renal impairment (72% had an estimated glomerular filtration rate <60 mL/min/1.73 m2). Patients in RED-HF had heart failure of longer duration [5.3 (5.4) years], worse NYHA class (35% II, 63% III, and 2% IV), and more signs of congestion. Mean EF was 30% (6.8%). RED-HF patients were well treated at randomization, and pharmacological therapy at baseline was broadly similar to that of other recent trials, taking account of study-specific inclusion/exclusion criteria. Median (interquartile range) haemoglobin at baseline was 112 (106–117) g/L.</p> <p>Conclusion: The anaemic patients enrolled in RED-HF were older, moderately to markedly symptomatic, and had extensive co-morbidity.</p&gt

An Italian Guidance Model for the Management of Suspected or Confirmed COVID-19 Patients in the Primary Care Setting

An outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 started in China's Hubei province at the end of 2019 has rapidly become a pandemic. In Italy, a great number of patients was managed in primary care setting and the role of general practitioners and physicians working in the first-aid emergency medical service has become of utmost importance to coordinate the network between the territory and hospitals during the pandemic. Aim of this manuscript is to provide a guidance model for the management of suspected, probable, or confirmed cases of SARS-CoV-2 infection in the primary care setting, from diagnosis to treatment, applying also the recommendations of the Italian Society of General Medicine. Moreover, this multidisciplinary contribution would analyze and synthetize the preventive measures to limit the spread of SARS-CoV-2 infection in the general population as well as the perspective for vaccines

Trueness and precision of 5 intraoral scanners in the impressions of single and multiple implants: a comparative in vitro study

BackgroundUntil now, a few studies have addressed the accuracy of intraoral scanners (IOSs) in implantology. Hence, the aim of this in vitro study was to assess the accuracy of 5 different IOSs in the impressions of single and multiple implants, and to compare them.MethodsPlaster models were prepared, representative of a partially edentulous maxilla (PEM) to be restored with a single crown (SC) and a partial prosthesis (PP), and a totally edentulous maxilla (TEM) to be restored with a full-arch (FA). These models were scanned with a desktop scanner, to capture reference models (RMs), and with 5 IOSs (CS 3600 (R), Trios3 (R), Omnicam (R), DWIO (R), Emerald (R)); 10 scans were taken for each model, using each IOS. All IOS datasets were loaded into a reverse-engineering software where they were superimposed on the corresponding RMs, to evaluate trueness, and superimposed on each other within groups, to determine precision. A statistical analysis was performed.ResultsIn the SC, CS 3600 (R) had the best trueness (15.20.8m), followed by Trios3 (R) (22.3 +/- 0.5m), DWIO (R) (27.8 +/- 3.2m), Omnicam (R) (28.4 +/- 4.5m), Emerald (R) (43.1 +/- 11.5m). In the PP, CS 3600 (R) had the best trueness (23 +/- 1.1m), followed by Trios3 (R) (28.5 +/- 0.5m), Omnicam (R) (38.1 +/- 8.8m), Emerald (R) (49.3 +/- 5.5m), DWIO (R) (49.8 +/- 5m). In the FA, CS 3600 (R) had the best trueness (44.9 +/- 8.9m), followed by Trios3 (R) (46.3 +/- 4.9m), Emerald (R) (66.3 +/- 5.6m), Omnicam (R) (70.4 +/- 11.9m), DWIO (R) (92.1 +/- 24.1m). Significant differences were found between the IOSs; a significant difference in trueness was found between the contexts (SC vs. PP vs. FA). In the SC, CS 3600 (R) had the best precision (11.3 +/- 1.1m), followed by Trios3 (R) (15.2 +/- 0.8m), DWIO (R) (27.1 +/- 10.7m), Omnicam (R) (30.6 +/- 3.3m), Emerald (R) (32.8 +/- 10.7m). In the PP, CS 3600 (R) had the best precision (17 +/- 2.3m), followed by Trios3 (R) (21 +/- 1.9m), Emerald (R) (29.9 +/- 8.9m), DWIO (R) (34.8 +/- 10.8m), Omnicam (R) (43.2 +/- 9.4m). In the FA, Trios3 (R) had the best precision (35.6 +/- 3.4m), followed by CS 3600 (R) (35.7 +/- 4.3m), Emerald (R) (61.5 +/- 18.1m), Omnicam (R) (89.3 +/- 14m), DWIO (R) (111 +/- 24.8m). Significant differences were found between the IOSs; a significant difference in precision was found between the contexts (SC vs. PP vs. FA).Conclusions The IOSs showed significant differences between them, both in trueness and in precision. The mathematical error increased in the transition from SC to PP up to FA, both in trueness than in precision