A case of disseminated BCG infection in a daughter of Italian immigrants in Switzerland

Bacillus Calmette-Guerin (BCG) is a vaccine against tuberculosis and contains a live, attenuated strain of Mycobacterium bovis as its essential constituent. Being a live, attenuated strain with potential pathogenicity, BCG can cause different complications, both near the inoculation site and through blood dissemination, especially in patients with immunodeficiency. IFN-gamma R1 deficiency is an autosomal recessively inherited immunodeficiency characterized by predisposition to infections with intracellular pathogens, in particular mycobacteria. We report a rare case of chronic osteomyelitis lasting 30 years due to BCG in a woman with IFN-gamma R1 deficiency who had previous clinical history of multi-organ BCGitis. Diagnosis of chronic osteomyelitis was confirmed by an 18-fluorine fluorodeoxyglucose positron emission tomography combined with CT scan (18F-FDG PET/CT). In children with a history of BCG vaccination and chronic unexplained infections, a clinical suspicion of BCG-related disease must arise, and a reason of immunodeficiency should be sought

PESFOR-W: Improving the design and environmental effectiveness of woodlands for water Payments for Ecosystem Services

ABSTRACT: The EU Water Framework Directive aims to ensure restoration of Europe?s water bodies to ?good ecological status? by 2027. Many Member States will struggle to meet this target, with around half of EU river catchments currently reporting below standard water quality. Diffuse pollution from agriculture represents a major pressure, affecting over 90% of river basins. Accumulating evidence shows that recent improvements to agricultural practices are benefiting water quality but in many cases will be insufficient to achieve WFD objectives. There is growing support for land use change to help bridge the gap, with a particular focus on targeted tree planting to intercept and reduce the delivery of diffuse pollutants to water. This form of integrated catchment management offers multiple benefits to society but a significant cost to landowners and managers. New economic instruments, in combination with spatial targeting, need to be developed to ensure cost effective solutions - including tree planting for water benefits - are realised. Payments for Ecosystem Services (PES) are flexible, incentive-based mechanisms that could play an important role in promoting land use change to deliver water quality targets. The PESFOR-W COST Action will consolidate learning from existing woodlands for water PES schemes in Europe and help standardize approaches to evaluating the environmental effectiveness and cost-effectiveness of woodland measures. It will also create a European network through which PES schemes can be facilitated, extended and improved, for example by incorporating other ecosystem services linking with aims of the wider forestscarbon policy nexus

Postpartum listeria meningitis

Listeria monocytogenes is a small Gram positive, intracellular bacillus known to cause a foodborne disease in immunocompromised patients and other high-risk groups. The infection that usually is asymptomatic or resembles a mild influenza like disease, in some risk groups can cause meningitis and brain abscesses. In pregnant women, L. monocytogenes may lead to abortion or delivery of an acutely ill infant. We describe a case of L. monocytogenes meningitis occurred in a young puerpera without immunological disorders or other risk factors. We think that because the puerperium is accompanied by the same physiological changes in immune response that features pregnancy, a higher infectious risk should be considered during this period of woman's life. Therefore, an empiric antimicrobial therapy also for listeriosis should be promptly started in meningitis that arises in post-partum period so to achieve the best outcome of the infection

Epidemiology of Anaplastic Large Cell Lymphoma Associated with Breast Implants: a quantitative analysis

Background and Objective: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare non-Hodgkin T-cell lymphoma arising in patients with breast reconstruction post-mastectomy or undergoing cosmetic-additive mammoplasty. Due to widespread use of implantations for cosmetic purposes, BIA-ALCL cases are expected to increase. We aimed at investigating main characteristics of the disease and factors predicting BIA-ALCL onset in patients with and without implant replacement. Method: A quantitative analysis was performed on cases extracted from primary studies published until April 2022 and searched in PubMed, Scopus and Google- Scholar databases, using “Breast-Implant” AND/OR “Associated” AND/OR “Anaplastic-Large-Cell-Lymphoma”. Statistical significance was verified by Student-T test for continuous variables, while Fisher’s exact test was applied for qualitative variables. Cox model with time-dependent covariates was applied to estimate BIA-ALCL’s onset time. Results: 232 patients with BIA-ALCL (mean age at diagnosis: 55 years-old; mean time to disease onset from first implant: 10.3 years) were extracted from 52 selected studies. Patients with cosmetic implants were younger than patients with post-mastectomy implants but no difference was showed for median time to onset. Patients with implant replacement were significantly older than patients without previous replacement at the diagnosis, having a median time to diagnosis since first implant of 13 years (7 years in patients without replacement). Hazard of developing BIA-ALCL resulted significantly lower inpatients having a previous implant replacement as compared to patients who did not (HR= 0.03; 95%CI: 0.005-0.19; p-value= <0.01). Conclusion: Exposure time to prosthesis, regardless of the age at implant and any possible condition associated with the disease, may play a role in BIA-ALCL induction. We provided evidence to be suggested for a proper information on breast implant use and for updating follow-up guidelines. Linkage between prosthetic implants registries and population-based cancer registries will help to better estimate the epidemiological impact over time of both BIA-ALCL and other lymphomas

Impact of Diabetes Mellitus and Its Comorbidities on Elderly Patients Hospitalized in Internal Medicine Wards: Data from the RePoSi Registry.

Background: Currently, diabetes represents the seventh leading cause of death worldwide, with a significant economic burden. The number and severity of comorbidities increase with age, and are identified as important determinants that influence the prognosis. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients affected by diabetes. Methods: In this observational study, we retrospectively analyzed data collected from the REgistro dei pazienti per lo studio delle POlipatologie e politerapie in reparti della rete Simi (RePoSi) registry. Socio-demographic, clinical characteristics, and laboratory findings were considered. The association between variables and in-hospital and 1-year follow-up were analyzed. Results: Among 4708 in-patients, 1378 (29.3%) had a diagnosis of diabetes. Patients with diabetes had more previous hospitalization, a clinically significant disability, and more need for a urinary catheter in comparison with subjects without diabetes. Patients affected by diabetes took more drugs, both at admission, at in-hospital stay, at discharge, and at 1-year follow-up. Thirty-five comorbidities were more frequent in patients with diabetes, and the first five were hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and chronic obstructive pulmonary disease (22.7%). Heart rate was an independent predictor of in-hospital mortality. At 1-year follow-up, cancer and male sex were strongly independently associated with mortality. Conclusions: Our findings showed the severity of the impact of diabetes and its comorbidities in the real life of internal medicine and geriatric wards, and provide data to be used for a better tailored management of elderly in-patients with diabetes