Detection of a novel bacterium of the genus Midichloria (family Midichloriaceae) in avian-borne Hyalomma marginatum ticks and their trans-Saharan migratory hosts

Introduction: Ticks are haematophagous ectoparasites of vertebrates habitually parasitizing avian species, which may contribute to tick dispersal across continents during migrations (Hasle 2013; Altizer et al., 2011). Midichloria bacteria can be transmitted to the vertebrate host during the tick bite (Bazzocchi et al., 2013; Serra et al., 2018). Although many avian species are common hosts of ticks harbouring Midichloria (e.g. Ixodes, Hyalomma), the circulation of this bacterium in birds has never been investigated. The aims of this study are: 1) evaluate the presence of Midichloria DNA in H. marginatum ticks and blood collected from trans-Saharan migratory birds; 2) quantify Midichloria bacteria in ticks through a novel quantitative PCR (qPCR).Material and methods: A total of 256 H. marginatum ticks and 97 blood samples were collected from three different migratory species (Phoenicurus phoenicurus, Saxicola rubetra and Sylvia communis) on Ventotene Island (Central Italy) and DNAs were extracted. A nested-PCR targeting the 16S rRNA gene of Midichloria was used to detect bacterial presence. Subsequently, primers targeting the gyrB gene of Midichloria and the cal gene of H. marginatum were designed and used in a qPCR for Midichloria quantification. Results were expressed as gyrB/cal copy numbers ratio.Results and discussion: 94% of Hyalomma ticks harbored DNA of Midichloria belonging to the monophylum associated with ticks, while the bacterial DNA was detected in 44.3% of blood samples. Furthermore, engorged ticks showed significantly higher bacteria load than unengorged ticks (Table 1; Wilcoxon sum-rank test: z=3.14; p=0.0017), similarly to what has been observed for M. mitochondrii in I. ricinus ticks.Conclusions: This work provides evidence for the presence of circulating Midichloria DNA in long-distance migratory birds, suggesting an enhanced worldwide spread of these bacteria across haematophagous ectoparasite populations. Future studies are necessary to increase the knowledge of Midichloria role in the biology of this tick species

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Prolonged higher dose methylprednisolone vs. conventional dexamethasone in COVID-19 pneumonia: a randomised controlled trial (MEDEAS)

Dysregulated systemic inflammation is the primary driver of mortality in severe COVID-19 pneumonia. Current guidelines favor a 7-10-day course of any glucocorticoid equivalent to dexamethasone 6 mg·day-1. A comparative RCT with a higher dose and a longer duration of intervention was lacking

Daytime non-invasive ventilatory support via intermittent abdominal pressure for a patient with Pompe disease

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Daytime non-invasive ventilatory support via intermittent abdominal pressure for a patient with Pompe disease

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Long-Term Data of Efficacy, Safety, and Tolerability in a Real-Life Setting of THC/CBD Oromucosal Spray-Treated Multiple Sclerosis Patients

Delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray was approved as add-on therapy for spasticity in patients with multiple sclerosis (MS). We show our 40-week postmarketing experience regarding efficacy and safety of THC/CBD spray in an Italian cohort of 102 MS patients. Patients were evaluated using the Expanded Disability Status Scale (EDSS) score, the Numerical Rating Scale (NRS) for spasticity, the Ambulation Index (AI), and Timed 25-Foot Walk (T25-FW) at the beginning of treatment and then every 3 months. After 4 weeks, if a clinically significant improvement in spasticity (at least 20% of baseline NRS score) was not seen, administration of the drug was stopped. In our cohort, patients received an average of 6.5 ± 1.6 sprays each day. The mean reduction to the NRS spasticity score was 2.5 ± 1.2 points (P <.0001). Thirty-seven patients (36.2%) discontinued the treatment. The incidence of adverse events (AEs) was 40.2%. Fifty-eight patients (56.9%) were also assessed using the NRS for pain, and 46 patients (45.1%) with bladder dysfunction were assessed for the IPSS (International Prostatic Symptoms Score) score, showing a significant improvement in these scales (P =.011 and P =.001, respectively). In conclusion, treatment with THC/CBD spray appears to be a valid answer to some of the unmet needs in MS patients, such as spasticity and other refractory-to-treatment symptoms

Gender differences in safety issues during Fingolimod therapy: Evidence from a real-life Relapsing Multiple Sclerosis cohort

Objective: Benefits and risks of new therapies in Multiple Sclerosis (MS) must be balanced carefully and tailored to patients. We aimed to describe our experience with Fingolimod (FTY), correlating demographics, clinical and hematological features of the Relapsing MS (RMS) cohort with the occurring Adverse Events (AEs). Material and Methods: Pretreatment screening tests, cardiological observation, and safety follow-up data were analyzed in 225 RMS patients. Changes in continuous data were analyzed post hoc with Wilcoxon ranks test; categorical variables were examined using McNemar test. Two-way repeated-measures analysis of variance (ANOVA) was used to analyze differences between baseline characteristic of the cohorts and Liver Function Tests (LFT) alterations. Binary logistic regression models were used to identify which of the baseline factors influenced LFT alterations and the occurrence of infections. Results: During 2 years of follow-up 24 patients (10%) interrupted FTY. Discontinuation most often was due to AEs (n = 14) or breakthrough disease (n = 5). The most frequently AEs were infections (10.6%). After the first year patients showing an infectious episode were mostly female (p =.04). The infections did not correlate with the decrease in white blood cells or to lymphocyte count. AST and ALT alterations â\u80\u8bâ\u80\u8bwere observed mostly in males (p =.002 and p =.01, respectively), and increase in GGT â\u80\u8bâ\u80\u8bwas reported in subjects older at FTY beginning (p <.05). Conclusions: For a patient-centered safety monitoring of FTY, we may apply gender-specific warnings, for the detection of transaminases abnormalities and infectious episodes