Legionella longbeachae and Endocarditis

We report a case of infectious endocarditis attributable to Legionella longbeachae. L. longbeachae is usually associated with lung infections. It is commonly found in composted waste wood products. L. longbeachae should be regarded as an agent of infectious endocarditis, notably in the context of gardening involving handling of potting soils

DEFHAZ: A Mechanistic Weather-Driven Predictive Model for Diaporthe eres Infection and Defective Hazelnut Outbreaks

The browning of the internal tissues of hazelnut kernels, which are visible when the nuts are cut in half, as well as the discolouration and brown spots on the kernel surface, are important defects that are mainly attributed to Diaporthe eres. The knowledge regarding the Diaporthe eres infection cycle and its interaction with hazelnut crops is incomplete. Nevertheless, we developed a mechanistic model called DEFHAZ. We considered georeferenced data on the occurrence of hazelnut defects from 2013 to 2020 from orchards in the Caucasus region and Turkey, supported by meteorological data, to run and validate the model. The predictive model inputs are the hourly meteorological data (air temperature, relative humidity, and rainfall), and the model output is the cumulative index (Dh-I), which we computed daily during the growing season till ripening/harvest time. We established the probability function, with a threshold of 1% of defective hazelnuts, to define the defect occurrence risk. We compared the predictions at early and full ripening with the observed data at the corresponding crop growth stages. In addition, we compared the predictions at early ripening with the defects observed at full ripening. Overall, the correct predictions were >80%, with <16% false negatives, which confirmed the model accuracy in predicting hazelnut defects, even in advance of the harvest. The DEFHAZ model could become a valuable support for hazelnut stakeholders

Diaporthe spp. Is Confirmed as the Main Fungus Associated with Defective Turkish Hazelnuts

The aim of this study was to identify the fungi associated with Turkish hazelnuts and verify and confirm the role of Diaporthe in causing kernel defects. Hazelnuts were sampled from ten hazelnut orchards in seven Turkish provinces (Samsun, Ordu, Girensun, Trabzon, Sakarya, Düzce, and Zonguldak) during the early and full ripening stages in 2018, 2019, and 2020. Fungal isolation and identification at the genus level were performed on healthy hazelnut kernels and those with visible or hidden defects. Several fungal genera were isolated; those with a mean incidence greater than 10% were Aspergillus, Botryosphaeria, Diaporthe, Fusarium, and Penicillium. The incidence of Diaporthe spp. was higher in the full ripening stage than in the early ripening stage; it was also higher in kernels with defects than in healthy kernels. A similar pattern was observed for Botryosphaeria, but the opposite pattern was observed for Aspergillus. Diaporthe positively correlated with both hidden (ρ=0.80) and visible defects (ρ=0.77) confirming its key role in causing hazelnut defects. The role of Botryosphaeria appears limited to hidden defects; however, additional work is needed to substantiate this last finding. There is also a need to clarify the eventual interaction of Diaporthe with Aspergillus. The low incidence of defective hazelnuts among the three years of sampling precluded the role of meteorological factors on the incidence of hazelnut defects from being elucidated

High dose esomeprazole as an anti-inflammatory agent in sepsis: Protocol for a randomized controlled trial

Background: Sepsis is caused by dysregulated immune responses due to infection and still presents high mortality rate and limited efficacious therapies, apart from antibiotics. Recent evidence suggests that very high dose proton pump inhibitors might regulate major sepsis mediators' secretion by monocytes, which might attenuate excessive host reactions and improve clinical outcomes. This effect is obtained with doses which are approximately 50 times higher than prophylactic esomeprazole single daily administration and 17 times higher than the cumulative dose of a three day prophylaxis. We aim to perform a randomized trial to investigate if high dose esomeprazole reduces organ dysfunction in patients with sepsis or septic shock. Methods: This study, called PPI-SEPSIS, is a multicenter, randomized, double blind, placebo-controlled clinical trial on critically ill septic patients admitted to the emergency department or intensive care unit. A total of 300 patients will be randomized to receive high dose esomeprazole (80 mg bolus followed by 12 mg/h for 72 h and a second 80 mg bolus 12 h after the first one) or equivolume placebo (sodium chloride 0.9%), with 1:1 allocation. The primary endpoint of the study will be mean daily Sequential Organ Failure Assessment (SOFA) score over 10 days. Secondary outcomes will include antibiotic-free days, single organ failure severity, intensive care unit-free days at day 28, and mortality. Discussion: This trial aims to test the efficacy of high dose esomeprazole to reduce acute organ dysfunction in patients with septic shock. Trial registration: This trial was registered on ClinicalTrials.gov with the trial identification NCT03452865 in March 2018

Prosafe: a european endeavor to improve quality of critical care medicine in seven countries

BACKGROUND: long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present ProsaFe, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. the project involved 343 icUs in seven countries. all patients admitted to the icU were eligible for data collection. MetHoDs: the ProsaFe network collected data using the same electronic case report form translated into the corresponding languages. a complex, multidimensional validation system was implemented to ensure maximum data quality. individual and aggregate reports by country, region, and icU type were prepared annually. a web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database. RESULTS: The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. conversely, icU equipment differed, and patient outcomes showed wide variations among countries. coNclUsioNs: ProsaFe is a permanent, stable, open access, multilingual database for clinical benchmarking, icU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor