Short-term increases of plasma cardiac troponin I are better evaluated by comparison with the reference change value

Introduction: We have investigated consecutive troponin I measurements using the Reference Change Value (RCV) at low concentrations, in patients admitted in Emergency Department (ED). Materials and methods: Patients admitted for chest pain (N = 103) were evaluated retrospectively on the basis of two consecutive cardiac tro-ponin-I (cTn-I) tests. The second test levels exceeding the "Critical Reference Change Value" (CrRCV), a quantity calculated on the basis of the first result and the RCV of cTn-I, were considered particularly relevant. Clinical cases were analysed matching the concentration change (significative or not) with acute coronary syndrome (clinically confirmed or not). Healthy individuals (N = 70) results and internal quality control results were evaluated for the calculation of, respectively, the biological and the analytical variation of plasma cTn-I. Results: The cTn-I RCV was very high because of the high analytical variation of cTn-I in proximity of its decision limit, as shown by its imprecision profile study. Analysing data with the first result < 0.1 µg/L we have obtained an cTn-I RCV negative predictive value - NPV = 88% (95% CI = 82-92%). The 4 groups of patients have demonstrated a clinically significant difference (Chi square test; P < 0.001). Conclusions: The RCV allows to statistically evaluating the cTn-I increased levels in presence of the high imprecision of commercial cTn-I assay at low concentrations. This parameter could be applied in medical practice only for low cTn-I concentrations around the decision limit for the myocardial necrosis

PRAME Expression in Mucosal Melanoma of the Head and Neck Region

PRAME (PReferentially expressed Antigen in MElanoma), a cancer-testis antigen expressed in normal and neoplastic tissues with several functions, proved to be a useful diagnostic tool in the differential diagnosis between benign and malignant melanocytic lesions. The current study aims to perform PRAME stain on a retrospective case series of mucosal melanocytic tumors of the head and neck region to compare 3 different scores and evaluate the most reliable one in this diagnostic set. Immunohistochemical analysis for PRAME was performed in 54 benign and malignant mucosal melanocytic tumors of the head and neck region collected from 41 patients. The best-performing cutoff of PRAME-positive cells (nuclear stain) to differentiate benign and malignant mucosal melanocytic tumors of the head and neck region is that proposed by Raghavan and colleagues (&lt;60%/≥60% of PRAME-positive cells), with 100% and 77.8% of benign lesions and malignant tumors respectively correctly identified. Applying this score, PRAME stain showed the best results (sensitivity, specificity, accuracy, and positive and negative predictive values) for the diagnosis of head and neck melanocytic tumors. However, a subset of PRAME-negative malignant tumors was identified, especially located in the palatal area (hard and soft palate). Finally, high PRAME expression (≥60%) was associated with specific sites (nasal cavity/nasal septum/turbinates nasopharynx, and the maxillary sinus), nodular histotype, and female sex

Predicting needlestick and sharps injuries in nursing students: Development of the SNNIP scale

© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd. Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018–January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50–1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of “personal exposure” (4.06, SD 3.78) were reported by third-year students. Higher scores for “perceived benefits” of preventive behaviours (13.6, SD 1.46) were reported by second-year students

Risultati a lungo termine del trapianto di intestino/multiviscerale in relazione alla patologia di base: esperienza di un centro per adulti

Il trapianto di intestino/multiviscerale è assurto a terapia riconosciuta a livello internazionale per tutti i pazienti colpiti da insufficienza intestinale cronica irreversibile ed affetti dalle complicanze della nutrizione parenterale totale. La causa principale di questa tipologia di trapianto nella popolazione adulta è rappresentata dalla sindrome da intestino corto (SBS) ma alcune neoplasie (come la sindrome di Gardner – GS) e le dismotilità intestinali croniche (come la pseudo-ostruzione intestinale cronica – CIPO) sono state sottoposte a questa procedura trapiantologia in maniera crescente negli ultimi anni. In questo studio retrospettivo riportiamo la nostra casistica esaminata nel lungo termine dal punto di vista della patologia di base: sebbene il trapianto per SBS abbia confermato i buoni risultati raggiunti negli scorsi anni, anche i riceventi affetti da CIPO dimostrano oramai risultati paragonabili ai trapianti per SBS. Il nostro studio ha invece evidenziato come i pazienti affetti da GS debbano essere accuratamente selezionati prima di essere sottoposti a trapianto di intestino/multiviscerale gravato da una elevata' mortalita' postoperatoria

COVID-19 and the Brain: The Neuropathological Italian Experience on 33 Adult Autopsies

Neurological symptoms are increasingly recognized in SARS-CoV-2 infected individuals. However, the neuropathogenesis remains unclear and it is not possible to define a specific damage pattern due to brain virus infection. In the present study, 33 cases of brain autopsies performed during the first (February&ndash;April 2020) and the second/third (November 2020&ndash;April 2021) pandemic waves are described. In all the cases, SARS-CoV-2 RNA was searched. Pathological findings are described and compared with those presently published

Group A rotavirus surveillance before vaccine introduction in Italy, September 2014 to August 2017

IntroductionGroup A rotaviruses (RVA) are the leading cause of acute gastroenteritis (AGE) in young children, causing ca 250,000 deaths worldwide, mainly in low-income countries. Two proteins, VP7 (glycoprotein, G genotype) and VP4 (protease-sensitive protein, P genotype), are the basis for the binary RVA nomenclature. Although 36 G types and 51 P types are presently known, most RVA infections in humans worldwide are related to five G/P combinations: G1P[8], G2P[4], G3P[8], G4P[8], G9P[8].AimThis study aimed to characterise the RVA strains circulating in Italy in the pre-vaccination era, to define the trends of circulation of genotypes in the Italian paediatric population.MethodsBetween September 2014 and August 2017, after routine screening in hospital by commercial antigen detection kit, 2,202 rotavirus-positive samples were collected in Italy from children hospitalised with AGE; the viruses were genotyped following standard European protocols.ResultsThis 3-year study revealed an overall predominance of the G12P[8] genotype (544 of 2,202 cases; 24.70%), followed by G9P[8] (535/2,202; 24.30%), G1P[8] (459/2,202; 20.84%) and G4P[8] (371/2,202; 16.85%). G2P[4] and G3P[8] genotypes were detected at low rates (3.32% and 3.09%, respectively). Mixed infections accounted for 6.49% of cases (143/2,202), uncommon RVA strains for 0.41% of cases (9/2,202).ConclusionsThe emergence of G12P[8] rotavirus in Italy, as in other countries, marks this genotype as the sixth most common human genotype. Continuous surveillance of RVA strains and monitoring of circulating genotypes are important for a better understanding of rotavirus evolution and genotype distribution, particularly regarding strains that may emerge from reassortment events

Use of low-molecular weight heparin, transfusion and mortality in COVID-19 patients not requiring ventilation

: It is still debated whether prophylactic doses of low-molecular- weight heparin (LMWH) are always effective in preventing Venous Thromboembolism (VTE) and mortality in COVID-19. Furthermore, there is paucity of data for those patients not requiring ventilation. We explored mortality and the safety/efficacy profile of LMWH in a cohort of Italian patients with COVID-19 who did not undergo ventilation. From the initial cohort of 422 patients, 264 were enrolled. Most (n = 156, 87.7%) received standard LMWH prophylaxis during hospitalization, with no significant difference between medical wards and Intensive Care Unit (ICU). Major or not major but clinically relevant hemorrhages were recorded in 13 (4.9%) patients: twelve in those taking prophylactic LMWH and one in a patient taking oral anticoagulants (p: n.s.). Thirty-nine patients (14.8%) with median age 75 years.&nbsp;were transfused. Hemoglobin (Hb) at admission was significantly lower in transfused patients and Hb at admission inversely correlated with the number of red blood cells units transfused (p &lt; 0.001). In-hospital mortality occurred in 76 (28.8%) patients, 46 (24.3%) of whom admitted to medical wards. Furthermore, Hb levels at admittance were significantly lower in fatalities (g/dl 12.3; IQR 2.4 vs. 13.3; IQR 2.8; Mann-Whitney U-test; p = 0.001). After the exclusion of patients treated by LMWH intermediate or therapeutic doses (n = 32), the logistic regression showed that prophylaxis significantly and independently reduced mortality (OR 0.31, 95% CI 0.13-0.85). Present data show that COVID-19 patients who do not require ventilation benefit from prophylactic doses of LMWH