Effectiveness of add-on Pegylated interferon alfa-2a therapy in a Lamivudine-treated patient with chronic hepatitis B

Hepatitis B virus (HBV) surface antigen (HBsAg) to anti-HBsAg (anti-HBs) antibody seroconversion is the best, final objective for all available chronic hepatitis B (CHB) treatments. Unfortunately, this goal is rarely obtained with the currently utilized therapeutic approaches. Here we describe the case of a CHB patient who was very successfully treated with a particular therapeutic schedule. The patient was initially treated with lamivudine for four years. Subsequently, pegylated interferon alpha-2a was introduced for a period of one year. During this period of combined therapies, the patient showed a flare of aminotransferase values followed by complete normalization of liver biochemistry parameters and HBsAg/anti-HBs seroconversion that persisted up to 24 months after all therapies had been stopped

La consulenza tecnica d’Ufficio in tema di transessualismo alla luce del D.Lgs n. 150 del 2011: il contributo non sempre richiesto della medicina legale

A seguito delle modifiche apportate alla Legge n. 164/1982 dal Decreto Legislativo n. 150/2011, che non prevede più espressamente il richiamo alla possibilità di espletare una consulenza tecnica d’ufficio per lo studio delle condizioni psico-sessuali del soggetto transessuale, parte della dottrina medico-legale ha sollevato obiezioni circa il possibile restringimento delle indagini tecnico-peritali e quindi dell’apporto della disciplina medico-legale e psichiatrico-forense nei casi di rettificazione di attribuzione anagrafica del sesso. Partendo da tale assunto, gli autori hanno affrontato la tematica relativa alla consulenza tecnica di ufficio in tema di transessualismo, analizzando in particolare le professionalità richieste e la metodologia peritale da adottare nell’ambito della c.t.u. Al fine di tutelare maggiormente la salute psico-fisica del soggetto transessuale, è stata sottolineata l’importanza di un approccio multidisciplinare e, quindi, la necessità della nomina di un collegio peritale costituito da: uno specialista in Medicina Legale ed uno in Psichiatria. Al tempo stesso, è emerso come in realtà in alcuni Tribunali Italiani già prima della modifica legislativa fosse consuetudine basare il giudizio anche soltanto sulla documentazione allegata dall’istante e rilasciata dai vari centri autorizzati.Following the amendments made to the Law no. 164/1982, Legislative Decree no. 150/2011, which no longer expressly provides the possibility of carrying out a technical consultancy for the study of psycho-sexual conditions of the transsexual subject, part of Legal-Medicine interpretation has questioned the possible narrowing of technical-expert surveys and therefore the contribution of Legal Medicine and Mental-Forensic disciplines in cases of rectification of sex registry attribution. Starting from this assumption, the authors addressed the issue concerning the technical consultancy on the subject of transsexualism, focusing on the skills required and on the expert's methodology to be adopted in the c.t.u. field. In order to better protect the mental and physical health of transsexual subject, the importance of a multidisciplinary approach, and so the need of the appointment of an expert panel composed by one specialist in Forensic Medicine and one in Psychiatry have been stressed. At the same time, it emerged that in fact in some Italian Courts, already before the legislative amendment, was customary to base the judgment even only on the documentation attached by the applicant and released from various authorized centers

Improving building energy modelling by applying advanced 3D surveying techniques on agri-food facilities

Food industry is the production sector with the highest energy consumption. In Europe, the energy used to produce food accounts for 26% of total energy consumption. Over 28% is used in industrial processes. Recently, European food companies have increased their efforts to make their production processes more sustainable, also by giving preference to the use of renewable energy sources. In Italy, the total energy consumption in agriculture and food sectors decreased between 2013 and 2014, passing from 16.79 to 13.3 Mtep. Since energy consumption in food industry is nearly twice the one in agriculture (8.57 and 4.73 Mtep, respectively), it is very important to improve energy efficiency and use green technologies in all the phases of food processing and conservation. In Italy, a recent law (Legislative Decree 102, 04/07/2014) has made energy-use diagnosis compulsory for all industrial concerns, particularly for those showing high consumption levels. In the case of food industry buildings, energy is mainly used for indoor microclimate control, which is needed to ensure workers' wellbeing and the most favourable conditions for food processing and conservation. To this end, it is important to have tools and methods allowing for easy, rapid and precise energy performance assessment of agri-food buildings. The accuracy of the results obtainable from the currently available computational models depends on the grade of detail and information used in constructional and geometric modelling. Moreover, this phase is probably the most critical and time-consuming in the energy diagnosis. In this context, fine surveying and advanced 3D geometric modelling procedures can facilitate building modelling and allow technicians and professionals in the agri-food sector to use highly efficient and accurate energy analysis and evaluation models. This paper proposes a dedicated model for energy performance assessment in agri-food buildings. It also shows that using advanced surveying techniques, such as a terrestrial laser scanner and an infrared camera, it is possible to create a three-dimensional parametric model, while, thanks to the heat flow meter Accepted paper measurement method, it is also possible to obtain a thermophysical model. This model allows assessing the energy performance of agri-food buildings in order to improve the indoor microclimate control and the conditions of food processing and conservation

Metabolic and anti-inflammatory effects of a home-based programme of aerobic physical exercise

AimsRegular exercise demonstrated the ability to provide enormous benefits to many diseases, atherosclerotic-based, degenerative and neoplastic, but also to grant anti-inflammatory actions, assessed by various authors in different populations. Despite of these clear benefits, many patients are unable to attain long-term results through chronic physical activity for different causes. On this basis, the aim of our study was to assess the metabolic and anti-inflammatory effects of a home-based programme of fast walking in patients affected by metabolic syndrome (MS). Materials and methodsWe enrolled 176 subjects with MS as stated by ATP III criteria. Patients were invited to walk for 1h every day 5days a week for 24weeks. The walking velocity was required higher than the one retained comfortable' by the patient, previously assessed in the run-in visit. Monitoring of physical activity was carried out through an OMRON step counter type Walking Style II. All the subjects enrolled completed the training period. ResultsAfter the 24weeks of intervention body mass index changed from 31.59 to 29.23 (p<0.001); mean waist circumference passed from 105.19 to 100.06cm (p<0.001); mean fasting glucose changed from 119.76 to 114.32mg/dl (p<0.001); for diabetic population (n=70) mean glicated haemoglobin levels changed from 7.38% to 6.86% (p<0.001); total cholesterol levels from 192.15 to 185.78mg/dl (p<0.001); HDL cholesterol levels raised from 44.03 to 47.63mg/dl (p<0.001); triglycerides levels lowered from 148.29 to 135.20mg/dl (p<0.001); WBC changed from 7361.08 to 7022.56/mm(3) (p<0.001); hs-CRP from 0.55 to 0.28mg/dl (p<0.001); fibrinogen serum levels lowered from 339.68 to 314.86mg/dl (p<0.001). ConclusionsA long-term home-based programme of aerobic physical activity improves metabolic asset and reduces systemic inflammation in sedentary people

The supraventricular tachycardias: Proposal of a diagnostic algorithm for the narrow complex tachycardias

AbstractThe narrow complex tachycardias (NCTs) are defined by the presence in a 12-lead electrocardiogram (ECG) of a QRS complex duration less than 120ms and a heart rate greater than 100 beats per minute; those are typically of supraventricular origin, although rarely narrow complex ventricular tachycardias have been reported in the literature.As some studies document, to diagnose correctly the NCTs is an arduous exercise because sometimes those have similar presentation on the ECG. In this paper, we have reviewed the physiopathological, clinical, and ECG findings of all known supraventricular tachycardias and, in order to reduce the possible diagnostic errors on the ECG, we have proposed a quick and accurate diagnostic algorithm for the differential diagnosis of NCTs

Use of QT intervals for a more accurate diagnose of syncope and evaluation of syncope severity.

Abstract BACKGROUND: This study aimed to evaluate the use of QT intervals, their diagnostic predictive value in patients with syncope and their relationship with syncope severity. METHODS: One hundred and forty nine patients with a diagnosis of syncope were admitted to Internal Medicine departments at the University of Palermo, Italy, between 2006 and 2012, and 140 control subjects hospitalised for other causes were enrolled. QT maximum, QT minimum, QTpeak, QT corrected, QT dispersion and Tpeak-to-Tend interval were compared between two groups. The paper medical records were used for scoring with San Francisco Syncope Rule (SFSR), Evaluation of Guidelines in SYncope Study (EGSYS) score and Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score. RESULTS: Mean QTc (p 424.8 ms (sensibility: 81.88 - specificity: 57.86) showed the greatest predictive value for diagnosis of syncope. On the EGSYS score and on the OESIL score, QTc was significantly prolonged in high-risk patients compared with low-risk patients. On the San Francisco Syncope Rule, QTc and QTdisp were significantly prolonged in high-risk patients compared with low-risk patients. CONCLUSION: Mean QTc, mean QTdisp, mean TpTe, mean QTmax and mean QTpeak were significantly longer in patients with syncope compared with control subjects. Furthermore, prolonged QTc and QTdisp were associated with major severe syncope according to San Francisco Syncope Rule, EGSYS and OESIL risk scores

QT Indexes in Cirrhotic Patients: Relationship with Clinical Variables and Potential Diagnostic Predictive Value.

BACKGROUND AND AIMS: A wide spectrum of cardiovascular changes characterizes cirrhosis, ranging from subclinical alterations to hyperkinetic syndrome. We looked for ECG markers of ventricular repolarization in a population of patients with cirrhosis in comparison to patients without cirrhosis and we investigated the relationship between these and other clinical and laboratory variables. METHODS: In 149 patients with cirrhosis and 152 controls, we measured QT maximum interval (QTmax), QT corrected interval (QTc), QT minimum interval (QTmin), QT dispersion (QTdisp), QT peak and T peak-to-end (TpTe). RESULTS: In subjects with cirrhosis, in comparison with controls, we observed a higher mean QTmax, mean QTc, mean QTmin, mean QTdisp and mean TpTe. At Cox regression analysis, diastolic blood pressure and beta-blocker treatment were significantly associated with mean QTmax, hypertension with mean QTmin and mean QTc, diastolic blood pressure, beta-blockers and ACE-inhibitors/ARBs with QT disp, and beta-blockers with TpTe. Analysis of ROC curves showed a significant area under curve towards cirrhosis diagnosis, respectively, for a cut-off value of >400 msec of QTmax, >360 msec of QTmin, >450 msec of QTc, >105 msec of TpTe and >55 msec of QTdisp

DETECTION OF PLIO-QUATERNARY FAULTS IN MADONIE MOUNTAINS (SICILY) BY USING QUANTITATIVE GEOMORPHIC AND STRUCTURAL GEOLOGY ANALYSES

The Northern Madonie Mountains (Northern-Central Sicily), sector of the Sicilian Maghrebian chain, consist of a tectonic thrust system developed through two subsequent main contractional events: 1) a shallow-seated compressional event developed during the Middle-Upper Miocene; 2) a deep-seated transpressional event occuring since the Late Miocene. Lower Pliocene (Trubi) to Quaternary clastic deposits unconformably lie on the tectonic units and are partially involved by deformation. In the selected area, syntectonic sedimentary basins characters are able to define the timing of deformation only until the Lower Pliocene; to resolve this gap of information application of quantitative geomorphic techniques, based on relationships between tectonics and hydrographic network development could contribute to recognize and characterize Quaternary structures in areas where clayey/marly deposits, widely outcropping, are not marked by pervasive tectonic deformations. In order to define the geological setting of the study area and to detect Quaternary tectonic structures, geological, structural and geomorphological analyses have been carried out. Geological and structural analyses have shown: 1) characters and style of deformation of fold structures: two main systems of folds have been recognized - the early system NW-SE-trending is refolded by a later system (trends in the E-W to NE-SW range); 2) orientation and kinematics of faults related to superimposed compressional events: an early thrust system characterized by SW-ward tectonic transport; a later transpressive system consistent with a maximum compression oriented N-S ± 20°, and nearly horizontal. Although the occurence of two compressional deformation events, interplaying in the construction of the Sicilian chain, is well-known, the field data, here collected, help to better characterize the relationship between shallow-seated and deep-seated structures. Due to rare and thin Quaternary deposits, quantitative geomorphic analysis has been performed on the hydrographic network of the study area, because the river drainage of Sicily is believed to have developed during the Quaternary age. In particular, have been carried out: 1) azimuthal distribution analysis, by cumulative length, of stream channels related to different orders, taking into account structurally and lithologically homogeneous areas to evaluate the influence of Quaternary tectonics on the geometry of drainage patterns; NNW-SSE, NNE-SSW, E-W and N-S domains have been evidenced in lower orders of channels; 2) “azimuthal transect method”, performed along 16 suitable segments crossing previously inferred fault zones, able to detect possible Quaternary strike-slip kinematics. Progressive apparent rotations of stream channels have been found, documenting the occurence along the main rivers of Quaternary faults and suggesting both right-lateral (NNW-SSE oriented) and left-lateral (NE-SW oriented) kinematic components. The multidisciplinary approach used suggests the geological/geomorphological setting of the study area is influenced by Quaternary faults with strike-slip component, highlighting a general congruency between hydrography and tectonics

The Impact of the Seasonal and Geographical Distribution of Tuberculosis in Sicily: A 6-Year Retrospective Study (2018–2023)

Tuberculosis (TB) continues to be a major public health issue, with high mortality rates reported worldwide. It is worth noting that most of the hospitalizations for tuberculosis in the Sicilian region involve Italian-born individuals, underscoring the need to address this problem. Recent research on the geographic area and seasonality of infectious diseases, including tuberculosis, may aid in developing effective preventive measures. Objectives: This study aimed to evaluate the impact of the season and geographical area on tuberculosis disease prevalence in the Sicilian region. Methods: A retrospective study from January 2018 to May 2023 was conducted on patients with tuberculosis in the Sicilian region by analyzing computerized records on the Infectious Diseases Information System, currently named the Italian National Notification System (NSIS), of the Epidemiology Unit at Policlinico Paolo Giaccone University Hospital of Palermo and the Regional Reference Laboratory for Tuberculosis Surveillance and Control. Results: Eastern and Western Sicily were the geographical Sicilian areas with the highest frequency of patients with tuberculosis (52.2% and 42.6%, respectively). In comparison, Central Sicily had a significantly lower frequency of patients with tuberculosis (5.2%). Regarding the season, autumn was the season with the highest number of notification cases (28.9%), while spring was the season with the lowest frequency of patients with tuberculosis (19.7%). In autumn, we found significantly fewer patients with tuberculosis from Eastern Sicily (39.3%) and Central Sicily (1.5%), while Western Sicily had more patients with tuberculosis (59.3%). In spring, we found significantly more patients with tuberculosis from Eastern Sicily (64.1%), while Western and Central Sicily had significantly fewer patients with tuberculosis (23.9% and 12%, respectively). The presence of patients with tuberculosis did not significantly differ between geographical regions in summer and winter. Conclusions: Geographical area and seasonality significantly impact the distribution of tuberculosis cases in Sicily. These factors may be linked to different climatic conditions across the various geographical areas considered. Our findings suggest that climate can play a critical role in the spread of airborne infectious diseases, such as tuberculosis

In-vitro NET-osis induced by COVID-19 sera is associated to severe clinical course in not vaccinated patients and immune-dysregulation in breakthrough infection

: Since neutrophil extracellular traps formation (NET-osis) can be assessed indirectly by treating healthy neutrophils with blood-derived fluids from patients and then measuring the NETs response, we designed a pilot study to convey high-dimensional cytometry of peripheral blood immune cells and cytokines, combined with clinical features, to understand if NET-osis assessment could be included in the immune risk profiling to early prediction of clinical patterns, disease severity, and viral clearance at 28&nbsp;days in COVID-19 patients. Immune cells composition of peripheral blood, cytokines concentration and in-vitro NETosis were detected in peripheral blood of 41 consecutive COVID-19 inpatients, including 21 mild breakthrough infections compared to 20 healthy donors, matched for sex and age. Major immune dysregulation in peripheral blood in not-vaccinated COVID-19 patients compared to healthy subjects included: a significant reduction of percentage of unswitched memory B-cells and transitional B-cells; loss of naïve CD3+CD4+CD45RA+ and CD3+CD8+CD45RA+ cells, increase of IL-1β, IL-17A and IFN-γ. Myeloid compartment was affected as well, due to the increase of classical (CD14++CD16-) and intermediate (CD14++CD16+) monocytes, overexpressing the activation marker CD64, negatively associated to the absolute counts of CD8+ CD45R0+ cells, IFN-γ and IL-6, and expansion of monocytic-like myeloid derived suppressor cells. In not-vaccinated patients who achieved viral clearance by 28&nbsp;days we found at hospital admission lower absolute counts of effector cells, namely CD8+T cells, CD4+ T-cells and CD4+CD45RO+ T cells. Percentage of in-vitro NET-osis induced by patients' sera and NET-osis density were progressively higher in moderate and severe COVID-19 patients than in mild disease and controls. The percentage of in-vitro induced NET-osis was positively associated to circulating cytokines IL-1β, IFN-γ and IL-6. In breakthrough COVID-19 infections, characterized by mild clinical course, we observed increased percentage of in-vitro NET-osis, higher CD4+ CD45RO+ and CD8+ CD45RO+ T cells healthy or mild-COVID-19 not-vaccinated patients, reduced by 24&nbsp;h of treatment with ACE inhibitor ramipril. Taken together our data highlight the role of NETs in orchestrating the complex immune response to SARS-COV-2, that should be considered in a multi-target approach for COVID-19 treatment