The rapid spread of SARS-COV-2 Omicron variant in Italy reflected early through wastewater surveillance

The SARS-CoV-2 Omicron variant emerged in South Africa in November 2021, and has later been identified worldwide, raising serious concerns. A real-time RT-PCR assay was designed for the rapid screening of the Omicron variant, targeting characteristic mutations of the spike gene. The assay was used to test 737 sewage samples collected throughout Italy (19/21 Regions) between 11 November and 25 December 2021, with the aim of assessing the spread of the Omicron variant in the country. Positive samples were also tested with a real-time RT-PCR developed by the European Commission, Joint Research Centre (JRC), and through nested RT-PCR followed by Sanger sequencing. Overall, 115 samples tested positive for Omicron SARS-CoV-2 variant. The first occurrence was detected on 7 December, in Veneto, North Italy. Later on, the variant spread extremely fast in three weeks, with prevalence of positive wastewater samples rising from 1.0% (1/104 samples) in the week 5-11 December, to 17.5% (25/143 samples) in the week 12-18, to 65.9% (89/135 samples) in the week 19-25, in line with the increase in cases of infection with the Omicron variant observed during December in Italy. Similarly, the number of Regions/Autonomous Provinces in which the variant was detected increased from one in the first week, to 11 in the second, and to 17 in the last one. The presence of the Omicron variant was confirmed by the JRC real-time RT-PCR in 79.1% (91/115) of the positive samples, and by Sanger sequencing in 66% (64/97) of PCR amplicons. In conclusion, we designed an RT-qPCR assay capable to detect the Omicron variant, which can be successfully used for the purpose of wastewater-based epidemiology. We also described the history of the introduction and diffusion of the Omicron variant in the Italian population and territory, confirming the effectiveness of sewage monitoring as a powerful surveillance tool

The rapid spread of SARS-COV-2 Omicron variant in Italy reflected early through wastewater surveillance

The SARS-CoV-2 Omicron variant emerged in South Africa in November 2021, and has later been identified worldwide, raising serious concerns. A real-time RT-PCR assay was designed for the rapid screening of the Omicron variant, targeting characteristic mutations of the spike gene. The assay was used to test 737 sewage samples collected throughout Italy (19/21 Regions) between 11 November and 25 December 2021, with the aim of assessing the spread of the Omicron variant in the country. Positive samples were also tested with a real-time RT-PCR developed by the European Commission, Joint Research Centre (JRC), and through nested RT-PCR followed by Sanger sequencing. Overall, 115 samples tested positive for Omicron SARS-CoV-2 variant. The first occurrence was detected on 7 December, in Veneto, North Italy. Later on, the variant spread extremely fast in three weeks, with prevalence of positive wastewater samples rising from 1.0% (1/104 samples) in the week 5–11 December, to 17.5% (25/143 samples) in the week 12–18, to 65.9% (89/135 samples) in the week 19–25, in line with the increase in cases of infection with the Omicron variant observed during December in Italy. Similarly, the number of Regions/Autonomous Provinces in which the variant was detected increased fromone in the first week, to 11 in the second, and to 17 in the last one. The presence of the Omicron variant was confirmed by the JRC real-time RT-PCR in 79.1% (91/115) of the positive samples, and by Sanger sequencing in 66% (64/97) of PCR amplicons

The rapid spread of SARS-COV-2 Omicron variant in Italy reflected early through wastewater surveillance

The SARS-CoV-2 Omicron variant emerged in South Africa in November 2021, and has later been identified worldwide, raising serious concerns. A real-time RT-PCR assay was designed for the rapid screening of the Omicron variant, targeting characteristic mutations of the spike gene. The assay was used to test 737 sewage samples collected throughout Italy (19/21 Regions) between 11 November and 25 December 2021, with the aim of assessing the spread of the Omicron variant in the country. Positive samples were also tested with a real-time RT-PCR developed by the European Commission, Joint Research Centre (JRC), and through nested RT-PCR followed by Sanger sequencing. Overall, 115 samples tested positive for Omicron SARS-CoV-2 variant. The first occurrence was detected on 7 December, in Veneto, North Italy. Later on, the variant spread extremely fast in three weeks, with prevalence of positive wastewater samples rising from 1.0% (1/104 samples) in the week 5–11 December, to 17.5% (25/143 samples) in the week 12–18, to 65.9% (89/135 samples) in the week 19–25, in line with the increase in cases of infection with the Omicron variant observed during December in Italy. Similarly, the number of Regions/Autonomous Provinces in which the variant was detected increased from one in the first week, to 11 in the second, and to 17 in the last one. The presence of the Omicron variant was confirmed by the JRC real-time RT-PCR in 79.1% (91/115) of the positive samples, and by Sanger sequencing in 66% (64/97) of PCR amplicons. In conclusion, we designed an RT-qPCR assay capable to detect the Omicron variant, which can be successfully used for the purpose of wastewater-based epidemiology. We also described the history of the introduction and diffusion of the Omicron variant in the Italian population and territory, confirming the effectiveness of sewage monitoring as a powerful surveillance tool

Applicazione dei nuovi criteri diagnostici per Tremore Essenziale: risultati di uno studio retrospettivo su un'ampia coorte di pazienti

Il tremore è il più comune disturbo del movimento. Il principale tipo di tremore idiopatico è il Tremore Essenziale (TE), le cui caratteristiche eterogenee hanno reso difficoltosa la creazione di una classificazione universalmente accettata, e pertanto numerosi tentativi di categorizzazione si sono susseguiti negli anni. Nel Consesus Statement della Movement Disorder Society del 1997, è stato definito come un tremore bilaterale, prevalentemente simmetrico, posturale o cinetico, che coinvolga le mani e gli avambracci, e che sia visibile e persistente. Evidenze successive hanno messo in luce i numerosi limiti di questa definizione, portando alla formulazione di nuovi criteri classificativi basati su due assi principali: l’Asse 1, che specifica i connotati clinici, e l’Asse 2, che riguarda l’eziologia. Uno dei cambiamenti più significativi apportati è la suddivisione nel TE in due entità: TE e TE plus, quest’ultimo definito come un tremore che risponde ai criteri per TE con la presenza di segni neurologici aggiuntivi, definiti soft signs (e.g. tremore di riposo, compromissione della marcia in tandem, disturbi della memoria, atassia della marcia e dubbia postura distonica). Il nostro studio si propone di valutare l’applicabilità e l’utilità clinica dei nuovi criteri diagnostici su una coorte di 215 pazienti, con particolare riferimento al TE, e di esaminare le differenze demografiche e cliniche delle due categorie TE e TE plus. Infine, verrà presa in esame la relazione del TE con la malattia di Parkinson (MP). Dall’analisi dei dati, è emerso che le sindromi che compaiono più frequentemente nella nostra casistica sono il TE e il TE plus. Applicando la nuova classificazione all’esordio di malattia, si assiste ad una parziale redistribuzione delle categorie diagnostiche, con una riduzione del numero di pazienti classificati come TE (48,8% vs 58,6% secondo i precedenti criteri), che vengono riclassificati come TE plus o come tremore indeterminato. All’ultimo follow up clinico disponibile, si riscontra che il sottogruppo più frequente è il TE plus, seguito dal TE. I pazienti classificati come TE plus mostrano caratteristiche demografiche e cliniche differenti rispetto ai pazienti con TE, sebbene siano necessari ulteriori studi per ipotizzare che il TE plus rappresenti un sottogruppo di TE dal punto di vista clinico ed eziologico. Infine, è stata presa in esame la correlazione tra TE e MP: nella nostra casistica, solo 11 pazienti hanno ricevuto diagnosi di MP, numero che non consente di effettuare analisi statistiche mirate all’individuazione di un potenziale fenotipo tremorigeno. Abbiamo comunque identificato la presenza in questi pazienti di segni extrapiramidali estremamente sfumati, dato che depone per la possibilità che la MP che si sviluppa su un pregresso TE abbia un diverso decorso rispetto al fenotipo classico, ma sono richiesti ulteriori studi per analizzare questa correlazione. Nonostante i limiti riscontrati nell’applicazione dei criteri diagnostici e la necessità di ulteriori studi, i dati ottenuti sottolineano come la diversità supposta tra TE e TE plus possa essere una realtà tangibile e come la nuova classificazione consenta di classificare con una terminologia univoca e più accurata le diverse sindromi tremorigene riscontrabili nella pratica clinica

Cerebrospinal Fluid IgM and Oligoclonal IgG Bands in Multiple Sclerosis: A Meta-Analysis of Prevalence and Prognosis

The presence of intrathecal IgM synthesis (ITMS) has been associated with an aggressive multiple sclerosis (MS) clinical course. In the present systematic review, we aimed at assessing the prevalence of ITMS among different MS phenotypes. Moreover, we aimed at quantifying the risk of a second relapse in ITMS positive and oligoclonal IgG bands (OCGBs)-positive patients. We selected clinical studies reporting the ITMS prevalence assessed as oligoclonal IgM Bands (OCMBs), lipid-specific OCMBs (LS-OCMBs), and/or as an intrathecal IgM production > 0% (IgMLoc, Reiber formula). The overall prevalence of ITMS was higher in relapsing-remitting (RR) than clinically isolated syndrome (CIS) patients (40.1% versus 23.8%, p < 0.00001), while was in line with that detected in primary progressive MS (PPMS, 26.7%). Almost all patients (98%) with ITMS had also OCGBs. The risk of having a second relapse was higher in OCGBs positive patients (HR = 2.18, p = 0.007) but much higher in ITMS positive patients (HR = 3.62, p = 0.0005). This study revealed that the prevalence of ITMS is higher in RRMS patients. It suggests that the risk of having a second relapse, previously ascribed to OCGBs, may, to a certain extent, be related to the presence of intrathecal IgM