A Multiparametric Approach Based on NT-proBNP, ST2, and Galectin3 for Stratifying One Year Prognosis of Chronic Heart Failure Outpatients

Galectin-3 and ST2 are emerging biomarkers involved in myocardial fibrosis. We evaluate the relevance of a multiparametric biomarker approach based on increased serum levels of NT-proBNP, galectin-3, and ST2 in stratifying the prognosis of chronic heart failure (CHF) outpatients. In 315 CHF outpatients in stable clinical condition clinical and echocardiographic evaluations were performed. Routine chemistry and serum levels of NT-proBNP, galectin-3, and ST2 were also assessed. During a 12 month follow-up, cardiovascular death, and/or heart failure (HF) occurred in 64 patients. The presence of NT-proBNP, galectin-3, and ST2 were higher than the recommended cutoffs and were all associated with events at univariate Cox regression analysis, as well as in a multivariate analysis including the three biomarkers. When a score based on the number of biomarkers above the recommended cut-offs was used (in a range of 0–3), it was associated with events both with respect to the univariate (HR 2.96, 95% CI 2.21–3.95, p < 0.001, C-index 0.78) and the multivariate (HR 1.52, 95% CI 1.06–2.17, p: 0.023, C-index 0.87) analyses, after correction for the variables of a reference model. Our results suggest that an easy prognostic approach based on the combination of three biomarkers, although with partially-overlapping pathophysiological mechanisms, is able to identify patients with the highest risk of heart failure progression

Widespread microbiological groundwater contamination in the South-eastern Salento (Puglia-Italy)

In the Salento peninsula (Puglia Region, South-East Italy), underground waters are a fundamental resource for the population because they constitute the principal reservoir for drinking water and irrigation. They are, however, affected by overexploitation. The risk factors in the Salento arise mainly from anthropic activities, especially tourism and agriculture (leaking wells, sewage and inadequate waste disposal procedures). The Southern Salento is recognized to be at high risk of pathologies characterised by oral-faecal transmission. From 2001 to 2009 the incidence of typhoid fever in the Salento was 12.11/100000 inhabitants as against 2.91 in Italy. Enteritis caused by rotaviruses is an important cause of hospitalization of paediatric-aged children in the Salento, with high social costs. An effective monitoring system for the conservation and management of water bodies and the protection of public health is therefore fundamental. The present study sought to determine the microbiological and chemical-physical quality of groundwater in the Salento and to analyse the factors associated with contamination. The results indicated widespread pollution from salt and microbial contamination. Contamination from faecal microorganisms posed a significant risk of human infection in 100% of samples. Furthermore, the water was unsuitable even for irrigation in a high percentage of cases (31.8%), which is of considerable significance given that agriculture is one of the most important economic activities in the area under study. The high salt concentration was probably due to excessive extraction of water for intensive irrigation, especially in summer. Under these circumstances, some of mitigation activity is necessary. Furthermore, it would be advisable to decrease the pollution load from anthropic activities in the territory and to reduce water consumption in order to conserve groundwater resources especially. © 2011 The Royal Society of Chemistry

Dynamics of microbial autochthon populations and human impact on the harbour of Otranto (Lecce, Italy)

The purpose of our investigation was to assess the water quality around the harbour of Otranto (Lecce, Italy) through an approach that integrates the determination of the classic parameters within traditional microbiological monitoring (the faecal contamination indexes - total coliforms, faecal coliforms, and faecal streptococcus) with the study of autochthon microbiological populations dynamics (hydrocarbon-degrading bacteria and bioluminescent bacteria). The analysis of our data shows that the faecal contamination indexes have values below the limits fixed by the 76/160/EEC directive for the bathing waters, marking the good microbiological quality of these waters. The density of the hydrocarbon-degrading bacteria has been shown to be much higher in the areas designated for the ships' berthing and for the transit of the crafts; therefore, this parameter has shown itself to be useful in the assessment of hydrocarbon contamination in harbour areas. The bioluminescent component of the epibacteria community was set as a marker for the biological quality of the seawater: the relative abundance of the bioluminescent bacteria in the impacted sites is below 5%

Spatial distribution of fungal microflora in the sediment of a brackish lake (Lake Alimini Grande, Italy) used for fish production and bathing

A study of the distribution of fungal microflora was conducted on the sediment of Lake Alimini Grande in order to contribute to the evaluation of the ecosystem characteristics that can effect the process of decomposition. The isolation and identification of fungal species and ergosterol analysis were performed on sediment samples taken from 33 monitoring stations in autumn and winter. Altogether, 24 strains belonging to 8 genera were isolated. Trichoderma spp (41.6%) and Aspergillus spp (20.8%) were the dominant genera: in particular, Trichoderma was present near the Traugnano marsh, whereas Aspergillus was isolated in the area of connection to the sea

Stepwise approach for diagnosis and management of Takotsubo syndrome with cardiac imaging tools

Takotsubo syndrome is featured by transient left ventricle dysfunction in the absence of significant coronary artery disease, mainly triggered by emotional or physical stress. Its clinical presentation is similar to acute coronary syndrome; therefore, cardiac imaging tools have a crucial role. Coronary angiography is mandatory for exclusion of pathological stenosis. On the other side, transthoracic echocardiography is the first non-invasive imaging modality for an early evaluation of left ventricle systolic and diastolic function. Left ventricle morphologic patterns could be identified according to the localization of wall motion abnormalities. Moreover, an early identification of potential mechanical and electrical complications such as left ventricle outflow tract obstruction, mitral regurgitation, thrombus formation, right ventricular involvement, cardiac rupture, and cardiac rhythm disorders could provide additional information for clinical management and therapy. Because of the dynamic evolution of the syndrome, comprehensive serial echocardiographic examinations should be systematically performed. Advanced techniques, including speckle-tracking echocardiography, cardiac magnetic resonance, and nuclear imaging can provide mechanistic and pathophysiologic insights into this syndrome. This review focuses on these aspects and provide a stepwise approach of all cardiac imaging tools for the diagnosis and the management of Takotsubo syndrome

On the role of skin biopsy in the diagnosis of calcific uremic arteriolopathy. A case-based discussion

Calciphylaxis is a rare disease characterized by ectopic calcification of skin arterioles resulting in ischemia, thrombosis and necrosis. Since end stage renal disease patients are those mainly affected, the term calcific uremic arteriolopathy (CUA) is also suggested. Early clinical manifestations are subtle, while overt necrotic ulcers may quickly spread and become infected so as to result in ominous outcome. Diagnosis might not be easy due to the number of other ischemic and non-ischemic skin lesions observed in uraemia. Skin biopsy, has been proposed as the diagnostic test and is often considered, but not systematically performed due to the hypothetical risk of further spreading of the lesions. Such ambiguity could be responsible for misdiagnosis or underdiagnosis. We review here five consecutive cases recorded in our Unit, all submitted to skin biopsy but with inconsistent results which generated some clinical frustration. Thus, we decided to carefully re-evaluate all of them together with pathologists and dermatologists. However, even after this ex-post discussion, we could not reach a complete agreement on the final diagnosis. In the meanwhile, papers were published in the literature that started to shed some light on the role of skin biopsy in the diagnosis of CUA

Association between high Gal-3 serum levels and worsening of renal function in chronic heart failure outpatients

Aim: The aim of the study was to evaluate the association between Gal-3 serum levels and the progression of renal dysfunction in chronic heart failure outpatients. Methods & results: This prospective study of 260 chronic heart failure patients showed that Gal-3 was associated with 1-year worsening of renal function both in univariate (odds ratio: 1.12; 95% CI: 1.06-1.18; p < 0.001) and in forward stepwise multivariate (odds ratio: 1.09; 95% CI: 1.03-1.15; p = 0.004) logistic regression analyses. Moreover, high Gal-3 levels at baseline were associated with a progressive decline in the estimated glomerular filtration rate. Conclusion: Gal-3 is a biomarker associated with the progression of renal function decline thus further supporting its possible usefulness in predicting cardiorenal syndrome progression