Sexually transmissible infections among young adolescents in Milan areas: a multicentre study

Objective: Sexually transmitted infections (STIs) are a major health problem affecting mostly young people, the exact magnitude of STIs is frequently unknown due to lack of country surveillance systems. Aim of this study was to determine the prevalence of STIs and relative risk factors among and adolescents in Milan areas, Italy. Methods: From May to October 2011, 117 adolescents (63 female, 54%), median age 15 years, attending hospitals from the north-western areas of Milan, Italy, were enrolled. All subjects completed a questionnaire and provided a urine sample, which was tested for Neisseria gonorrhea, Chlamidia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum/parvum, Trichomonas vaginalis, Treponema pallidum, Streptococcus agalatiae, Haemophylus ducrey, Citomegalovirus (CMV), Herpes Simplex Virus 1(HSV1) and Lymphogranuloma venereum by a multiplex PCR assay: Seeplex\uae STI Master ACE Detection (Seegene, Seoul, Korea). Forty tree out of 117 adolescents (36%) were HIV-1 positive, 63% (74/117) were without any underlying infectious disease. Results: Fifty seven (48,7%) out of 117 adolescent were sexually active (SA), 20 out of 57 (35%) had STIs as follow: 24.5% (14 cases) U.urealyticum/parvum, 7% (4cases) C.trachomatis, 1.7% (one case each) M. genitalium and N.gonorrhoea. Thirty-two (56%) out of 57 SA adolescents were HIV-1 positive and infected with U. urealyticum/parvum (37.5%, 12 cases) and C.trachomatis (6.2% 2 cases). A single case (3.1%) of mixed infection due to C.trachomatis, N.gonorrhoea and U.urealyticum/parvum was observed. Six out of 60 (10%) sexually inactive (SI) adolescents resulted positive for U.urealyticum/parvum (3 cases), C.trachomatis (2 cases) and N.gonorrhoea (1 case). Eleven out of 60 were HIV-1 positive and among this group one case of C.trachomatis and U.urealyticum/parvum infection was reported. For T.vaginalis, T. pallidum, S. agalatiae, H.ducrey, CMV, HSV1 and Lymphogranuloma venereum any infection was reported. Conclusion: STIs as expected were higher in SA adolescent than in SI and in HIV-1 positive patients (P <0.025).Twenty-two percent of SA adolescents resulted positive for at least one STIs. A prevalence of 14.5% (17/117) for U. urealyticum/parvum, was detected in the adolescents studied, even if its clinical significance has yet to be assessed. Findings suggest that surveillance and screening programs should be implemented to prevent sequels on this vulnerable population

Human papillomavirus 9-valent vaccine for cancer prevention: a systematic review of the available evidence.

In 2014, the Food and Drug Administration approved a new human papillomavirus 9-valent vaccine (9vHPV), targeting nine HPV types: HPV types 6, 11, 16, and 18, which are also targeted by the quadrivalent HPV vaccine (qHPV), plus five additional high cancer risk HPV types (HPV types 31, 33, 45, 52, and 58). The aim of the current study was to systematically retrieve, qualitatively and quantitatively pool, as well as critically appraise all available evidence on 9vHPV from randomized controlled trials (RCTs). We conducted a systematic review of the literature on 9vHPV efficacy, immunogenicity and safety, as well as a systematic search of registered, completed, and ongoing RCTs. We retrieved and screened 227 records for eligibility. A total of 10 publications reported on RCTs' results on 9vHPV and were included in the review. Sixteen RCTs on 9vHPV have been registered on RCT registries. There is evidence that 9vHPV generated a response to HPV types 6, 11, 16 and 18 that was non-inferior to qHPV. Vaccine efficacy against five additional HPV type-related diseases was directly assessed on females aged 16-26 years (risk reduction against high-grade cervical, vulvar or vaginal disease = 96·7%, 95% CI 80·9%-99·8%). Bridging efficacy was demonstrated for males and females aged 9-15 years and males aged 16-26 years (the lower bound of the 95% CIs of both the geometric mean titer ratio and difference in seroconversion rates meeting the criteria for non-inferiority for all HPV types). Overall, 9vHPV has been proved to be safe and well tolerated. Other RCTs addressed: 9vHPV co-administration with other vaccines, 9vHPV administration in subjects that previously received qHPV and 9vHPV efficacy in regimens containing fewer than three doses. The inclusion of additional HPV types in 9vHPV offers great potential to expand protection against HPV infection. However, the impact of 9vHPV on reducing the global burden of HPV-related disease will greatly depend on vaccine uptake, coverage, availability, and affordability

The Role of Virulence Factors in Neonatal Sepsis Caused by Enterobacterales: A Systematic Review.

Neonatal sepsis is a life-threatening condition with high mortality. Virulence determinants relevant in causing Gram-negative (GN) neonatal sepsis are still poorly characterized. A better understanding of virulence factors (VFs) associated with GN neonatal sepsis could offer new targets for therapeutic interventions. The aim of this review was to assess the role of GN VFs in neonatal sepsis. We primarily aimed to investigate the main VFs leading to adverse outcome and second to evaluate VFs associated with increased invasiveness/pathogenicity in neonates. MEDLINE, Embase, and Cochrane Library were systematically searched for studies reporting data on the role of virulome/VFs in bloodstream infections caused by Enterobacterales among neonates and infants aged 0-90 days. Twenty studies fulfilled the inclusion criteria. Only 4 studies reported data on the association between pathogen virulence determinants and neonatal mortality, whereas 16 studies were included in the secondary analyses. The quality of reporting was suboptimal in the great majority of the published studies. No consistent association between virulence determinants and GN strains causing neonatal sepsis was identified. Considerable heterogeneity was found in terms of VFs analysed and reported, included population and microbiological methods, with the included studies often showing conflicting data. This variability hampered the comparison of the results. In conclusions, pathogens responsible for neonatal sepsis are widely heterogenous and can use different pathways to develop invasive disease. The recent genome-wide approach needs to include multicentre studies with larger sample sizes, analyses of VF gene profiles instead of single VF genes, alongside a comprehensive collection of clinical information. A better understanding of the roles of virulence genes in neonatal GN bacteraemia may offer new vaccine targets and new markers of highly virulent strains. This information can potentially be used for screening and preventive interventions as well as for new targets for anti-virulence antibiotic-sparing therapies

Gastrointestinal Symptoms in Severe COVID-19 Children.

There are growing evidence of clinical manifestations other than acute respiratory syndrome in severe acute respiratory syndrome associated with coronavirus 2-infected children. In our multicenter retrospective analysis, we observed among 127 severe acute respiratory syndrome associated with coronavirus 2 positive children that the presence of gastrointestinal symptoms was more frequently associated with severe and critical phenotype (P = 0.029). Moreover, having gastrointestinal symptoms was more frequently reported in patients who developed cardiac impairment

Antiretroviral therapy and pregnancy,: effect on cortical bone status of HIV-infected women

Antiretroviral therapy and pregnancy: effect on cortical bone status of HIV-infected wome

Antibiotic Susceptibility, Virulome and Clinical Outcomes in European Infants with Bloodstream Infections Caused by Enterobacterales

Mortality in neonates with Gram-negative bloodstream infections has remained unacceptably high. Very few data are available on the impact of resistance profiles, virulence factors, appropriateness of empirical treatment and clinical characteristics on patients’ mortality. A survival analysis to investigate 28-day mortality probability and predictors was performed including (I) infants <90 days (II) with an available Enterobacterales blood isolate with (III) clinical, treatment and 28-day outcome data. Eighty-seven patients were included. Overall, 299 virulence genes were identified among all the pathogens. Escherichia coli had significantly more virulence genes identified compared with other species. A strong positive correlation between the number of resistance and virulence genes carried by each isolate was found. The cumulative probability of death obtained by the Kaplan-Meier survival analysis was 19.5%. In the descriptive analysis, early age at onset, gestational age at onset, culture positive for E. coli and number of classes of virulence genes carried by each isolate were significantly associated with mortality. By Cox multivariate regression, none of the investigated variables was significant. This pilot study has demonstrated the feasibility of investigating the association between neonatal sepsis mortality and the causative Enterobacterales isolates virulome. This relationship needs further exploration in larger studies, ideally including host immunopathological response, in order to develop a tailor-made therapeutic strategy