Colonization by Legionella spp. of water networks in residential buildings of the Province of Pisa, Italy

Despite the increase of community acquired cases of legionellosis in Italy over the last years, the Italian guidelines do not give indications for prevention and control of Legionella in the hot water networks (or centralized conditioning systems) of residential buildings. We performed a survey on eight medium sized apartment buildings in the Pisa district to assess the prevalence of Legionella spp. in the water network and the respondance to drinking water requisites at the point of use, according to the Italian norms

Massive splenic infarction in a patient with pneumococcal septic shock and unknown celiac disease

Splenic infarction (SI) is a rare event occurring when the splenic artery or its branches become occluded by embolus or by in situ thrombosis. Many SI events are a result of embolic sources either cardiac or aortic. Massive splenic infarction (MSI) results from compromised blood flow to more than half of the spleen. In this paper we describe a case of a previously healthy patient who presented with pneumococcal sepsis who, upon investigation, revealed an unknown celiac disease and a MSI. Abdominal ultrasound with contrast agent was a useful tool for a diagnosis and follow up of this patient

Unplanned readmissions within 30 days after discharge: Improving quality through easy prediction

Objective: To propose an easy predictive model for the risk of rehospitalization, built from hospital administrative data, in order to prevent repeated admissions and to improve transitional care. Design: Retrospective cohort study. Setting: Azienda Ospedaliero Universitaria Pisana (Pisa University Hospital). Participants: Patients residing in the territory of the province of Pisa (Tuscany Region) with at least one unplanned hospital admission leading to a medical Diagnosis-Related Group (DRG) in the calendar year 2012. Intervention: We compared two groups of patients: patients coded as 'RA30' (readmitted within 30 days after the previous discharge) and patients coded as 'NRA30' (either admitted only once or readmitted after 30 days since the latest discharge). Main Outcome Measures: The effect of age, sex, length of stay, number of diagnoses, normalized number of admissions and presence of diseases on the probability of rehospitalization within 30 days after discharge was evaluated. Results: The significant variables included in the predictive model were: age, odds ratio (OR) = 1.018, 95% confidence interval (CI) = 1.011-1.026; normalized number of admissions, OR = 1.257, CI = 1.225-1.290; number of diagnoses, OR = 1.306, CI = 1.174-1.452 and presence of cancer diagnosis, OR = 1.479, CI = 1.088-2.011. Conclusions: The model can be easily applied when discharging patients who have been hospitalized after an access to the Emergency Department to predict the risk of rehospitalization within 30 days. The prediction can be used to activate focused hospital-primary care transitional interventions. The model has to be validated first in order to be implemented in clinical practice

Label-free immunodetection of α-synuclein by using a microfluidics coplanar electrolyte-gated organic field-effect transistor

The aggregation of α-synuclein is a critical event in the pathogenesis of neurological diseases, such as Parkinson or Alzheimer. Here, we present a label-free sensor based on an Electrolyte-Gated Organic Field-Effect Transistor (EGOFET) integrated with microfluidics that allows for the detection of amounts of α-synuclein in the range from 0.25 pM to 25 nM. The lower limit of detection (LOD) measures the potential of our integrated device as a tool for prognostics and diagnostics. In our device, the gate electrode is the effective sensing element as it is functionalised with anti-(α-synuclein) antibodies using a dual strategy: i) an amino-terminated self-assembled monolayer activated by glutaraldehyde, and ii) the His-tagged recombinant protein G. In both approaches, comparable sensitivity values were achieved, featuring very low LOD values at the sub-pM level. The microfluidics engineering is central to achieve a controlled functionalisation of the gate electrode and avoid contamination or physisorption on the organic semiconductor. The demonstrated sensing architecture, being a disposable stand-alone chip, can be operated as a point-of-care test, but also it might represent a promising label-free tool to explore in-vitro protein aggregation that takes place during the progression of neurodegenerative illnesses.This work was funded by the EXPLORA project MAT2015-72760-EXP (Spanish Ministry) and ERC StG 2012–306826 e-GAMES (European Research Council FP7). The authors also thank the Spanish Ministry of Economy and Competitiveness, through the projects FANCY CTQ2016-80030-R, GENESIS PID2019-111682RB-I00 and “Severo Ochoa” Programme for Centers of Excellence in R&D (SEV-2015-0496), the Generalitat de Catalunya (2017-SGR-918) and the Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN). S. R. is enrolled in the PhD program of the Universitat Autònoma of Barcelona (UAB). The research leading to these results has also received funding from the People Programme (Marie Curie Actions) of the Seventh Framework Programme of the European Union (FP7/2007–2013) under Research Executive Agency Grant Agreement No. 600388 (TECNIOSpring programme), and from the Agency for Business Competitiveness of the Government of Catalonia, ACCIÓ. The Surface Plasmon Resonance (SPR) measurements were performed through the ICTS NANBIOSIS platform, more specifically in the Biodeposition and Biodetection Unit of the CIBER in Bioengineering, Biomaterials & Nanomedicine (CIBER-BBN) at the Catalan Institute of Nanoscience and Nanotechnology (ICN2). The microfluidic device design and fabrication were performed with funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement 764281 (AiPBAND), and Marie Skłodowska-Curie grant agreement 813863 (BORGES).Peer reviewe

ADOZIONE DI UN SISTEMA DI ALERT ELETTRONICO PER LA SORVEGLIANZA E IL CONTROLLO DELLE INFEZIONI DA ACINETOBACTER BAUMANII NELL’AZIENDA OSPEDALIERO UNIVERSITARIA PISANA (A.O.U.P)

Introduzione. Acinetobacter baumannii è un importante patogeno opportunista responsabile di gravi infezioni correlate all’assistenza (ICA) La resistenza agli antimicrobici rappresenta il principale vantaggio selettivo che consente al microrganismo di diffondere in ambiente ospedaliero, considerata anche la capacità intrinseca del batterio di persistere nell’ambiente a lungo. In Italia Acinetobacter baumanii è responsabile del 5,7% delle ICA e nel 50% degli isolati è stata riscontrata resistenza combinata. La conoscenza precoce di pazienti infetti o colonizzati attraverso sistemi di alert elettronici generati dal laboratorio di microbiologia in tempo reale permette al gruppo aziendale di intervenire attraverso le misure di controllo e la terapia antiinfettiva appropriata. Metodi. A partire dai referti degli alert elettronici è stato creato un database in cui sono riportati gli identificativi del paziente, il reparto richiedente e il tipo di campione. Quotidianamente viene valutata la presenza di cluster epidemici nei reparti a maggior rischio e mensilmente viene restituito ai direttori di dipartimento un report sulle infezioni nei reparti afferenti. Sulla base della positività a campioni richiesti a scopo diagnostico o di sorveglianza, i pazienti sono distinti in colonizzati o infetti. Risultati. Dei 101 pazienti per cui abbiamo avuto almeno un alert positivo, 66 (65,3%) erano infetti e 35 (34,6%) colonizzati. I reparti ad alta intensità di cure sono risultati i più critici: Anestesia e Rianimazione di Urgenza con 17 pazienti infetti (26%) e 3 (8,5%) colonizzati; Chirurgia generale dei trapianti con 13 (20%) infetti e 10 (28,5%) colonizzati; Centro Ustioni con 5 (7,6%) infetti e 2 (5,8%) colonizzati. Il rapporto colonizzati infetti è 0,53. Conclusioni. L’implementazione del sistema di alert elettronico rappresenta un valido strumento di sorveglianza delle infezioni da Acinetobacter baumanii al fine di adottare tempestivamente misure di controllo

Pulmonary scintigraphy as a method to investigate gastrobronchial communication in tracheostomized patients

Amyotrophic Lateral Sclerosis (ALS) is a degeneration of somatic motor neurons extending from upper motor cortical pyramidal neurons to lower motor neurons of the brainstem and cord. During the course of the disease patients require invasive procedures for nutrition and ventilation. Percutaneous Endoscopic Gastrostomy (PEG), performed in patients with impaired swallowing, is a safe procedure for the administration of Enteral Nutrition (EN). In the advanced stages of the disease patients develop a ventilatory failure due to muscolar weakness in these case they need a permanent tracheal tube with mechanical ventilation. Here we reported a case of a patient with Amyotrophic Lateral Sclerosis (ASL) who developed an increased gastric endocavitary pressure after a Percutaneous Endoscopic Gastrostomy (PEG)

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