Adrenal pheochromocytoma incidentally discovered in a patient with parkinsonism

To evaluate the diagnostic route of pheochromocytoma (PHEO) in a patient under dopaminergic treatment. A 70-year-old man with Parkinsonism and under treatment with levodopa and carbidopa came to our observation for evaluation of arterial hypertension and right adrenal mass discovered incidentally. To evaluate adrenal hormone levels we performed a dexamethasone suppression test, plasma aldosterone levels and 24-hr urinary metanephrine, which revealed elevated levels of catecholamines metabolities. 123-I-metaiodobenzylguanidine SPECT scintiscan revealed raised activity within the right adrenal gland concordant with the mass. The diagnosis of PHEO was posed and an elective laparoscopic adrenalectomy was performed; histopathological examination confirmed the PHEO diagnosis. Recently the coexistence of PHEO and Parkinsonism is a very rare association of diseases, with only 3 cases reported in literature. In this article, another case is reported and diagnostic procedures are discusse

Epidemiologia delle infezioni da amebe a vita libera

Le amebe a vita libera (spesso conosciute come Free-Living Amoebae, FLA) sono protozoi presenti in tutte le matrici ambientali a diffusione cosmopolita. L’etichetta di organismi “a vita libera” deriva dal fatto che il loro serbatoio è l’ambiente acquatico naturale, e quello realizzato dall’uomo è un habitat secondario favorevole. Sono protozoi unicellulari che possono vivere all’interno di un ospite in condizioni di parassitismo facoltativo o avere un’esistenza autonoma. Per tale proprietà sono anche definite amebe anfizoiche. In particolare, anche se in realtà è Acanthamoeba spp. il protozoo più frequentemente rilevabile nell’ambiente, amebe a vita libera sono state isolate da suolo, sedimenti, polveri, aria, acque naturali e reflue, dolci, marine, termali, e sono state anche rilevate in acque confezionate, potabilizzate e sottoposte a trattamenti di disinfezione (acque destinate al consumo umano e di piscina) e in biofilm. Numerose specie di amebe a vita libera sono state segnalate in torri di raffreddamento, impianti di climatizzazione, deumidificatori, unità di dialisi, riuniti dentistici, apparecchi per il trattamento domestico dell’acqua e su lenti a contatto. Individuate nell’uomo e in animali a sangue caldo e freddo, in soggetti malati sono state isolate da ferite, dalla cornea, dai polmoni e dal sistema nervoso centrale, anche se la loro presenza è stata dimostrata anche in individui sani. La loro distribuzione e diversità nell’ambiente sono fortemente influenzate da temperatura, umidità, pH, disponibilità di nutrienti e appare chiara l’esistenza di un loro andamento stagionale. In condizioni ambientali ostili le amebe producono cisti che excistano solo in condizioni favorevoli liberando trofozoiti. Sopravvivenza e moltiplicazione sono anche associate sia alla presenza di batteri, soprattutto Gram-negativi, sia alla concentrazione degli stessi batteri. Infatti, con rapporti di concentrazione ameba: batteri di 1:104, lo sviluppo dei protozoi è inibito. Per il basso numero di infezioni riscontrate, le amebe non hanno mai rappresentato un argomento sanitario di interesse prioritario, anche se la mancanza di farmaci efficaci e l’esito quasi sempre fatale delle malattie indotte da alcune specie, le hanno sempre rese oggetto di interesse e di studio. Negli ultimi decenni tuttavia, un’attenzione particolare è stata loro rivolta per il ruolo che rivestono come veicolo di trasmissione di microrganismi patogeni presenti nell’ambiente idrico. Infatti, circa un quarto degli isolati di origine ambientale, clinica o derivanti da lenti a contatto contengono microrganismi endosimbionti, definiti Amoeba-Resistant Microorganisms (ARM), microrganismi resistenti alle amebe, che sono in grado di mantenere la loro vitalità a livello intracellulare. Le amebe fungono così da riserva per altri microrganismi, proteggendoli da fattori ambientali ostili e fornendo condizioni favorevoli alla loro replicazione. Per questa circostanza, nel 2017, presso la III Sezione del Consiglio Superiore di Sanità, presieduta dalla Prof.ssa Anna Teresa Palamara, e coordinata dalla Dott.ssa Anna Gaspardone, è stato istituito un Gruppo di Lavoro il cui compito è stato quello sia di approfondire gli aspetti sanitari associati alle amebe a vita libera rilevabili nelle acque, sia di valutare la rilevanza del problema in un’ottica di salvaguardia della salute. A seguito delle attività del Gruppo di lavoro è stato quindi predisposto il documento condiviso e di seguito presentato che produce informazioni sulle caratteristiche tassonomiche ed ecologiche di questi organismi, sulle loro possibili implicazioni di carattere sanitario, sul loro adattamento nelle reti di distribuzione idrica e sulle dinamiche di interazione con gli altri microrganismi. Inoltre, il volume fornisce un indirizzo metodologico univoco e specifiche raccomandazioni per minimizzare il rischio associato alla presenza di amebe nell’ambiente idrico, nonché, in Appendice, metodi analitici colturali e molecolari per la ricerca di questi organismi nelle acque

Omission of dry period and effects on the subsequent lactation curve and on milk quality around calving in Italian Holstein cows

The aim of this study was to investigate the effect of dry period omission on subsequent milk production over a whole lactation and the effect on milk quality around calving. Seventeen Italian Friesian cows, homogeneous for milk yield and parity, were managed either with a traditional dry-off period of 55d (CTR group; n=8) or continuously milked up to parturition (CON group; n=9). Milk yield was recorded daily from 75±7 d before expected calving date to the end of subsequent lactation to fit the lactation curve. Before parturition milk samples were collected at -70 d, -60 d, and -55 d for CTR and CON groups and at -40 d, -30 d, and -7 d for CON cows. After calving, six milk samples were taken from 1d to 90 d from both groups and analyzed for fat, protein, lactose, MUN and somatic cells. Body weight (BW) and body condition (BCS) were obtained 7 times from -55 d before expected calving to 90 d after calving. The omission of the dry period modified the shape of lactation in CON cows that reached the peak 10 d earlier and producing - 5.5 kg/d than CTR. Over a 305 d period, the milk yield reduction was of -2241 kg in CON group. The higher amount of milk produced before calving, i.e., 560 kg of milk in 52 d of mean pre-partum period, did not compensate the milk yield reduction after a continuous lactation. Milk quality was unaffected by the omission of dry period after calving, and animals in both lactation groups showed a similar decreasing trends over time for fat and protein, and increasing trends for lactose and MUN. Somatic cell score remained higher (4.54 vs 3.40) in CON than in CTR cows after calving. No different BW or BCS changes were observed for both groups after calving. We conclude that despite the absence of great differences in milk quality, the complete omission of the dry period in cows reduce significantly the milk yield, suggesting no economical benefit from this management strategy

Factors influencing persistence of Legionella pneumophila serogroup 1 in laboratory cocultures

Background: Risk for infections from Legionella pneumophila for immunocompromised individuals increases greatly when this species is present within the biofilm of the water distribution systems of hospitals or other health facilities. Multiplication and persistence of Legionella may dependent also upon planktonic growth in alternative to sessile growth. Here we compared the persistence of L. pneumophila serogroup 1 in experimental planktonic co-cultures subsided with iron, Pseudomonas aeruginosa and other non Legionella bacteria (quantified as Heterotrophic Plate Count, HPC at 37°C), isolated from drinking water sources of a large hospital. Results: Concentrations of L. pneumophila showed a decreasing pattern with incubation time in all co-cultures, the degree of reduction depending on the experimental treatment. In co-cultures with added P. aeruginosa, no L. pneumophila was detectable already after 4 days of incubation. In contrast in co-cultures without P. aeruginosa, HPC but not iron were significant factors in explaining the pattern of L. pneumophila, although the HPC effect was different according to the incubation time (HPC x time interaction, p < 0.01). Conclusions: Our results highlight the need of controlling for both HPC and metal constituents of the water systems of buildings used by individuals at particular risk to the effects of Legionella exposure

Pseudo-outbreak of Mycobacterium gordonae in a teaching hospital: importance of strictly following decontamination procedures and emerging issues concerning sterilization

Aim of this study was to investigate a pseudo-outbreak of Mycobacterium gordonae analyzing isolates detected from clinical and environmental samples. Mycobacterium gordonae was detected in 7 out of 497 broncho-alveolar lavage (BAL) samples after bronchoscopy procedure in patients admitted to a teaching hospital between January and April 2013. During this pseudo-outbreak clinical, epidemiological, environmental and molecular investigations were performed. None of the patients met the criteria for non-tuberculous mycobacterial (NTM) lung disease and were treated for M. gordonae lung disease. Environmental investigation revealed M. gordonae in 3 samples: in tap water and in the water supply channel of the washer disinfector. All the isolates were subjected to genotyping by pulsed-field gel electrophoresis (PFGE). The PFGE revealed that only patients' isolates presented the same band pattern but no correlation with the environmental strain was detected. Surveillance of the outbreak and the strict adherence to the reprocessing procedure and its supplies resulted afterwards in no detection of M. gordonae in clinical respiratory samples. Clinical surveillance of patients was crucial to establish the start of NTM treatment. Regular screening of tap water and endoscopic equipment should be adopted to compare the clinical strains with the environmental ones when an outbreak occurs

Medicolegal issues in power morcellation: cautionary rules for gynecologists to avoid unfavorable outcomes

Power morcellation in laparoscopic surgery enables specialists to carry out minimally invasive procedures such as hysterectomies and myomectomies by cutting specimens into smaller pieces using a rotating blade and removing pieces through a laparoscope. Unexpected uterine sarcoma treated by surgery involving tumor disruption could be associated with poor prognosis. The current study aims to shed light on power morcellation from a medicolegal perspective: the procedure has resulted in adverse outcomes and litigation, and compensation for plaintiffs, as published in various journals cited in PubMed and MEDLINE, Cochrane Library, EMBASE, and GyneWeb. Considering the claims after the US Food and Drug Administration warnings on morcellation, the current study broadens the scope of research by including search engines, legal databases, and court filings (DeJure, Lexis Nexis, Justia, superior court of New Jersey, and US district court of Minnesota) between 1995 and 2019. Legal records show that courts determine professional responsibility regarding complications, making it essential to document adherence to safety protocols and specific guidelines, when available. Sound medical practices and clearly stated institute best practices result in better patient outcomes and are important when unfavorable clinical outcomes occur; adverse legal decisions can be avoided if there are grounds to prove professional conformity with specific guidelines and the unpredictability of an event

The prevalence of resistant arterial hypertension and secondary causes in a cohort of hypertensive patients: a single center experience

The prevalence of resistant hypertension (RHT) still remains unknown. Aim of the study was to investigate in a large cohort of hypertensive patients the prevalence of RHT, and to identify in these patients the secondary forms of arterial hypertension (SH). We enrolled a series of 3685 consecutive hypertensive patients. All patients underwent complete physical examination, laboratory tests, screening for SH. Ambulatory blood pressure monitoring (ABPM) was performed to exclude white-coat hypertension. Further, we investigated for any obstructive sleep apnea syndrome (OSA). Only 232 (5.8%) hypertensive patients fulfilled criteria for RHT. 91 (39%) had a SH; 56 (61%) hypertensive patients had a primary aldosteronism, 22 (24%) had OSA, 7 (7.7%) had a hypercortisolism, and 5 (5.5%) had a renovascular hypertension (RVH). Only one patient had adrenal pheochromocytoma. An accurate definition and investigation into RHT is needed. We recommend ABPM to all patients at diagnosis. Finally, all patients must be screened for SH, such as adrenal hypertension, OSA and RVH, especially those who are apparently resistant to polypharmacological treatment

The effects of painless nerve growth factor on human microglia polarization

Previous studies in the rat suggest that microglial cells represent a potential druggable target for nerve growth factor (NGF) in the brain. The painless human Nerve Growth Factor (hNGFp) is a recombinant mutated form of human nerve growth factor (hNGF) that shows identical neurotrophic and neuroprotective properties of wild-type NGF but displays at least 10-fold lower algogenic activity. From the pharmacological point of view, hNGFp is a biased tropomyosin receptor kinase A (TrkA) agonist and displays a significantly lower affinity for the p75 neurotrophin receptor (p75NTR). This study aimed to evaluate the expression of TrkA and p75NTR NGF receptors in two different human microglia cell lines, and to investigate the effects of hNGFp and wild-type NGF (NGF) on L-arginine metabolism, taken as a marker of microglia polarization. Both NGF receptors are expressed in human microglia cell lines and are effective in transducing signals triggered by NGF and hNGFp. The latter and, to a lesser extent, NGF inhibit cytokine-stimulated inducible nitric oxide synthase (iNOS) expression and nitric oxide (NO) production in these cells. Conversely NGF but not hNGFp stimulates arginase-mediated urea production

Preventive medicine center and health care for students of medicine and health professions at the Sapienza University of Rome: a research protocol

This project aims to develop a Center of Preventive Medicine and Health Care for the students of Medicine and Health profession at Sapienza University of Rome. At the beginning of the university career students, both residents and nonresident s, have to face several difficulties such as: starting smoking or the increase in cigarette consumption ; the independent management of their own health (especially for non residents consequently to the distance of the family doctor) ; unhealthy diet; tuberculosis (TB) biological risk during their university training. These aspects , especially if present at the same time, act as a source stress and adversely affect the quality of life and the academic performance. Specific aims of the project will be: implementing an ambulatory of Preventive Medicine; implementing a virtual ambulatory of general medicine; creating a website on the problems mentioned above. Data collected will be computerized to keep an electronic health record (HER) and to use the information for the purposes of scientific research. The Centre will act in close relationship with the Central Administration, with the Headmasters of the Medical Faculties, and in close collaboration with the Center of Occupational Medicine of Sapienza University