Climate Change and the Potential Spreading of Marine Mucilage and Microbial Pathogens in the Mediterranean Sea

Background: Marine snow (small amorphous aggregates with colloidal properties) is present in all oceans of the world. Surface water warming and the consequent increase of water column stability can favour the coalescence of marine snow into marine mucilage, large marine aggregates representing an ephemeral and extreme habitat. Marine mucilage characterize aquatic systems with altered environmental conditions. Methodology/Principal Findings: We investigated, by means of molecular techniques, viruses and prokaryotes within the mucilage and in surrounding seawater to examine the potential of mucilage to host new microbial diversity and/or spread marine diseases. We found that marine mucilage contained a large and unexpectedly exclusive microbial biodiversity and hosted pathogenic species that were absent in surrounding seawater. We also investigated the relationship between climate change and the frequency of mucilage in the Mediterranean Sea over the last 200 years and found that the number of mucilage outbreaks increased almost exponentially in the last 20 years. The increasing frequency of mucilage outbreaks is closely associated with the temperature anomalies. Conclusions/Significance: We conclude that the spreading of mucilage in the Mediterranean Sea is linked to climate-driven sea surface warming. The mucilage can act as a controlling factor of microbial diversity across wide oceanic regions and could have the potential to act as a carrier of specific microorganisms, thereby increasing the spread of pathogenic bacteria

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

The (un)coupling between viruses and prokaryotes in the Gulf of Trieste

Viruses and prokaryotes represent the smallest and the most abundant biological entities in marine environments. The interest for viruses and their interactions with marine organisms is continuously rising but the studies are generally limited to short-time investigations. This study conducted in the Gulf of Trieste on monthly resolution investigates for the very first time relationships between viruses and prokaryotes (both heterotrophs-HP and autotrophs-AP) over ten years (2000e2010). From our results emerged that no clear relationship between the abundances of viruses and prokaryotes is observed unless for rather restricted time intervals. Some of the sporadic peaks of viral abundances can be attributable to infections occurred during the autumn phytoplankton blooms, thus probably contributing to the end of the bloom. We infer that the general uncoupling between viruses and prokaryotes in the Gulf of Trieste is due to the variety of factors that regulate viral infection, proliferation and persistence such as the diversity of viral life cycles that are determined by environmental factors, the abundance and the physiological status of their hosts

Carbon fluxes in the pelagic ecosystem of the Gulf of Trieste (Northern Adriatic Sea)

By measuring a broad suite of physical, chemical, and biological parameters coupled with experiments on grazing efficiency of mesozoo-, microzoo- and heteronano-plankton we were able to depict the seasonal trophic status of the pelagic system in the Gulf of Trieste over a period of 8 years from 1998 to 2005. In winter and spring, primary production exceeded respiration, the autotrophic fraction biomass was higher than the heterotrophic biomass. Moreover, predation on microphytoplankton and autotrophic nanoplankton largely structured the ecosystem and bacterial carbon production accounted for <50% of primary production. The ratio of primary production/respiration was higher than 1 in winter and spring suggesting that pelagic ecosystem was autotrophic whereas in summer and in autumn the ratio was lower than 1 suggesting a shift towards net heterotrophic status. Carbon export was possible in winter and in autumn, and the few data from the sediment trap supported the theoretical rates. Thus since spring most of the C fixed by photosynthesis remained segregated in the surface layer and possibly it was exported to the bottom through grazer fecal pellets. In summer the system was dominated by heterotrophic picoplankton, which showed the highest production rate. In this scenario we hypothesize that the DOC produced during the winter-spring period can sustain a high and active bacterial biomass that is the primary energy source for the whole system. Picoplankton communities were heavily grazed by microzooplankton and heteronano-plankton, moreover predation rates of mesozooplankton on microzooplankton were particularly high in summer. Despite the high variability typical of the coastal areas, the pelagic ecosystem during these 8 years has shifted seasonally from a nutrient-excited state (winterespring) to a background state (summereautumn) as it has been observed from open-ocean ecosystem. Understanding the dynamic and the magnitude of this variability-shift is rather compelling in order to give guidance in managing the Gulf area in the context of CO2 sequestration mitigation programs (carbon export downward flux) as well as for fishery economy

Acute disseminated encephalomyelitis after SARS-CoV-2 vaccination

Several central and peripheral nervous system complications associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection have been recently described. An effective mass vaccination program is necessary to effectively reduce infection spread and, consequently, limit long-term sequelae, including those affecting the nervous system. Nevertheless, as more patients gain access to coronavirus disease 2019 (COVID-19) vaccines, it is important to report potential adverse events. Herein, we report a patient with previous history of post-infectious rhombencephalitis who developed an acute disseminated encephalomyelitis (ADEM) two weeks after being vaccinated for COVID-19

Ultra-conservative fertility-sparing strategy for bilateral borderline ovarian tumours: An 11-year follow-up

This is a prospective long-term extension study of a randomized controlled trial aimed to assess the risk-benefit ratio of an ultra-conservative fertility-sparing approach in patients with bilateral borderline ovarian tumours (BOTs).The experimental group (n = 15) was treated with an ultra-conservative surgical approach consisting of bilateral cystectomy, whereas the control group (n = 17) received a less conservative surgery consisting of oophorectomy plus controlateral cystectomy alone. All patients received a complete laparoscopic staging followed by a fertility enhancement programme. Patients who completed childbearing were treated with a non-conservative standard treatment at the first recurrence.After a follow-up period of 128 (9 interquartile range (IQR); 115-150 range) and 132 (7 IQR; 117-152 range) months for the experimental and control groups, respectively (P = 0.25), the time to first baby-in-arm (P &lt; 0.02) and the relative rate (RR) of baby-in-arm (8.05 [95% confidence interval (CI), 1.20-9.66; P &lt; 0.01]) were significantly lower and higher, respectively, for the experimental compared with the control group. Although the time to first recurrence was significently (P &lt; 0.01) shorter for the experimental group, in the regression analysis the difference did not reach the statistic significance (P = 0.14), and the RR of recurrence (1.23 [95% CI, 0.62-3.17; P = 0.41]) was not significant. Finally the number needed to treat for pregnancy was three, the number needed to harm for radical surgery was only two.The ultra-conservative fertility-sparing approach is more effective than the standard approach in terms of reproductive outcomes, but presents a higher oncological risk