Epidemiologia delle infezioni da amebe a vita libera

Le amebe a vita libera (spesso conosciute come Free-Living Amoebae, FLA) sono protozoi presenti in tutte le matrici ambientali a diffusione cosmopolita. L’etichetta di organismi “a vita libera” deriva dal fatto che il loro serbatoio è l’ambiente acquatico naturale, e quello realizzato dall’uomo è un habitat secondario favorevole. Sono protozoi unicellulari che possono vivere all’interno di un ospite in condizioni di parassitismo facoltativo o avere un’esistenza autonoma. Per tale proprietà sono anche definite amebe anfizoiche. In particolare, anche se in realtà è Acanthamoeba spp. il protozoo più frequentemente rilevabile nell’ambiente, amebe a vita libera sono state isolate da suolo, sedimenti, polveri, aria, acque naturali e reflue, dolci, marine, termali, e sono state anche rilevate in acque confezionate, potabilizzate e sottoposte a trattamenti di disinfezione (acque destinate al consumo umano e di piscina) e in biofilm. Numerose specie di amebe a vita libera sono state segnalate in torri di raffreddamento, impianti di climatizzazione, deumidificatori, unità di dialisi, riuniti dentistici, apparecchi per il trattamento domestico dell’acqua e su lenti a contatto. Individuate nell’uomo e in animali a sangue caldo e freddo, in soggetti malati sono state isolate da ferite, dalla cornea, dai polmoni e dal sistema nervoso centrale, anche se la loro presenza è stata dimostrata anche in individui sani. La loro distribuzione e diversità nell’ambiente sono fortemente influenzate da temperatura, umidità, pH, disponibilità di nutrienti e appare chiara l’esistenza di un loro andamento stagionale. In condizioni ambientali ostili le amebe producono cisti che excistano solo in condizioni favorevoli liberando trofozoiti. Sopravvivenza e moltiplicazione sono anche associate sia alla presenza di batteri, soprattutto Gram-negativi, sia alla concentrazione degli stessi batteri. Infatti, con rapporti di concentrazione ameba: batteri di 1:104, lo sviluppo dei protozoi è inibito. Per il basso numero di infezioni riscontrate, le amebe non hanno mai rappresentato un argomento sanitario di interesse prioritario, anche se la mancanza di farmaci efficaci e l’esito quasi sempre fatale delle malattie indotte da alcune specie, le hanno sempre rese oggetto di interesse e di studio. Negli ultimi decenni tuttavia, un’attenzione particolare è stata loro rivolta per il ruolo che rivestono come veicolo di trasmissione di microrganismi patogeni presenti nell’ambiente idrico. Infatti, circa un quarto degli isolati di origine ambientale, clinica o derivanti da lenti a contatto contengono microrganismi endosimbionti, definiti Amoeba-Resistant Microorganisms (ARM), microrganismi resistenti alle amebe, che sono in grado di mantenere la loro vitalità a livello intracellulare. Le amebe fungono così da riserva per altri microrganismi, proteggendoli da fattori ambientali ostili e fornendo condizioni favorevoli alla loro replicazione. Per questa circostanza, nel 2017, presso la III Sezione del Consiglio Superiore di Sanità, presieduta dalla Prof.ssa Anna Teresa Palamara, e coordinata dalla Dott.ssa Anna Gaspardone, è stato istituito un Gruppo di Lavoro il cui compito è stato quello sia di approfondire gli aspetti sanitari associati alle amebe a vita libera rilevabili nelle acque, sia di valutare la rilevanza del problema in un’ottica di salvaguardia della salute. A seguito delle attività del Gruppo di lavoro è stato quindi predisposto il documento condiviso e di seguito presentato che produce informazioni sulle caratteristiche tassonomiche ed ecologiche di questi organismi, sulle loro possibili implicazioni di carattere sanitario, sul loro adattamento nelle reti di distribuzione idrica e sulle dinamiche di interazione con gli altri microrganismi. Inoltre, il volume fornisce un indirizzo metodologico univoco e specifiche raccomandazioni per minimizzare il rischio associato alla presenza di amebe nell’ambiente idrico, nonché, in Appendice, metodi analitici colturali e molecolari per la ricerca di questi organismi nelle acque

Translation, Linguistic Validation, and Readability of the Spanish Version of the VISA-H Scale in Elite Athletes

Object: Data regarding the diagnosis of Proximal Hamstring Tendinopathy (PHT) is limited. There is a need for a standardized, valid, and reliable instrument for evaluating PHT among Spanish population. The purpose of this study was to linguistically validate and cross-culturally adapt the Spanish version of the VISA-H for Spanish population and to assess its readability, initial feasibility, appropriateness and acceptability. Methods: Cross-cultural adaptation was done according to established guidelines. Process included 5 steps: independent translations, synthesis of the translations, back-translations, expert committee, and pre-test. The linguistic validation of the questionnaire followed a standard methodology that included comprehension test interviews to assess the relevance, understanding and acceptability of the VISA-H. Comprehension was analyzed with cognitive interviews of 18 Spanish Professional basketball and soccer players (n = 8 male, n = 10 female end-users, healthy individuals at risk), using think-aloud and probing techniques. Results: All subjects (18/18) reported that the items were clear and did not cause upset. Additionally, every respondent had no difficulty in completing the form and found it fairly easy. No difficulties with the instructions were reported. Readability score resulted in adequate levels of understanding (Fernandez-Huerta score of 67.5), showing high level of acceptability

Quality assessment of medical record as a tool for clinical risk management: a three year experience of a teaching hospital Policlinico Umberto I, Rome

Introduction: The medical record was defined by the Italian Ministry of Health in 1992 as "the information tool designed to record all relevant demographic and clinical information on a patient during a single hospitalization episode". Retrospective analysis of medical records is a tool for selecting direct and indirect indicators of critical issues (organizational, management and technical). The project’s aim being the promotion of an evaluation and self-evaluation process of medical records as a Clinical Risk Management tool to improve the quality of care within hospitals. Methods: The Authors have retrospectively analysed, using a validated grid, 1,184 medical records of patients admitted to the Teaching Hospital “Umberto I” in Rome during a three-year period (2013-2015). Statistical analysis was performed using SPSS for Windows © 19:00. All duly filled out criteria (92) were examined. “Strengths” and "Weaknesses" were identified through data analysis and Best and Bad Practice were identified based on established criteria. Conclusion: The data analysis showed marked improvements (statistically significant) in the quality of evaluated clinical documentation and indirectly upon behaviour. However, when examining some sub-criteria, critical issues emerge; these could be subject to future further corrective action

Regular and moderate exercise initiated in middle age prevents age-related amyloidogenesis and preserves synaptic and neuroprotective signaling in mouse brain cortex

Abstract Although the beneficial responses induced in the central nervous system by early-initiated exercise have been broadly investigated, the effects of a chronic and moderate lately-initiated exercise on biochemical hallmarks of very early brain senescence have not been extensively studied. We previously reported that a midlife-initiated regimen of moderate running was able not only to prevent the age-related decay of antioxidative and detoxification functions in mouse brain cortex, but also to preserve neurotrophic support and molecular integrity. On this basis, this work investigated whether and how a 2-mo or 4-mo midlife-initiated running protocol could affect the activity of those systems involved in maintaining neuronal function and in preventing the onset of neurodegeneration within the brain cortex of middle-aged CD-1 mice. In particular, we analyzed the production of the peptide amyloid-β and the expression of synapsin Ia, which is known to play a key role in neurotransmission and synaptic plasticity. In addition, we studied the expression of sirtuin 3, as a protein marker of neuroprotection against age-dependent mitochondrial dysfunction, as well as the pro-death pathway induced by proBDNF through the interaction with p75NTR and the co-receptor sortilin. The midlife-initiated 4-mo running program triggered multiple responses within the mouse brain cortex, through the activation of anti-amyloidogenic, pro-survival, synaptogenic and neuroprotective pathways. However, most of the beneficial actions of the exercise regimen appeared only after 4 months, since 2-mo-exercised mice showed marked impairments of the endpoints we considered. This could imply that a midlife-initiated regimen of moderate treadmill running may require an adequate time lag to activate beneficial compensative mechanisms within the mouse brain cortex

Evidence that chronic hypoxia causes reversible impairment on male fertility

Aim: To evaluate the effect of chronic hypoxia on human spermatogenic parameters and their recovery time. Methods: Seminological parameters of six male healthy mountain trekkers were evaluated in normoxia at sea level. After 26 days exposure to altitude (ranging from 2 000 m to 5 600 m, Karakorum Expedition) the same parameters were again evaluated after returning to sea level. These parameters were once again evaluated after 1 month and then again after 6 months. Results: Sperm count was found to be lower immediately after returning to sea level (P = 0.0004) and again after a month (P = 0.0008). Normal levels were reached after 6 months. Spermatic motility (%) shows no reduction immediately after returning to sea level (P = 0.0583), whereas after 1 month this reduction was significant (P = 0.0066). After 6 months there was a recovery to pre-hypoxic exposure values. Abnormal or immature spermatozoa (%) increased immediately after returning to sea level (P = 0.0067) and then again after 1 month (P = 0.0004). After 6 months there was a complete recovery to initial values. The total number of motile sperm in the ejaculate was found to be lower immediately after returning to sea level (P = 0.0024) and then again after 1 month (P = 0.0021). After 6 months there was a recovery to pre-hypoxic exposure values. Conclusion: Chronic hypoxia induces a state of oligospermia and the normalization of such seminological parameters at the restoration of previous normoxic conditions after 6 months indicate the influence of oxygen supply in physiological mechanisms of spermatogenesis and male fertility. (Asian J Androl 2008 Jul; 10: 602–606

Effects of a curcumin-based supplementation in asymptomatic subjects with low bone density: a preliminary 24-week supplement study

Osteopenia is a chronic bone condition characterized by decreased calcification, density, or bone mass that, if untreated, can lead to osteoporosis and bone fractures. Although its increasing prevalence, nowadays osteopenia is not adequately prevented and managed. In this study, we evaluated the efficacy, in term of changes in bone density, and safety of an oral formulation based on turmeric phytosome (Meriva\uae), in subjects suffering from low bone density

Effect of virtual reality rehabilitation on functional outcomes for return-to-work patients with Parkinson's disease: an umbrella review of systematic reviews

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disease characterized by loss of substantia nigra neurons with deficiency of dopamine. The main symptoms are tremor, rigidity and bradykinesia. Rehabilitation has an important role in the treatment of this condition and virtual reality (VR) is one of the most recent tools. OBJECTIVE: The purpose of this umbrella review is to evaluate the effectiveness of VR systems on gait control for return to work in patients with PD. METHODS: The electronic search, for reviews and meta-analysis studies that investigated the effectiveness of VR on gait control in PD patients, was performed through December 2021 using the following databases: PubMed, Scopus, PEDro, and Google Scholar. Mesh terms used were: Job integration/reintegration OR return-to-work AND Parkinson's disease AND virtual reality OR exergame. No limit on the year of publication of the article was used. CONCLUSIONS: A total of 14 articles were included in our analysis. The included evidence shows a stride length improvement in patients treated with VR compared to conventional active treatments. No difference was found in walking speed. Also, the included articles show an improvement on various measures of balance, motor function and severity of PD motor symptoms. In addition, the literature shows an improvement in the quality of life and neuropsychiatric symptoms in patients undergoing VR rehabilitation training. RESULTS: he results of our study suggest that VR rehabilitation improves gait performance, particularly stride length, thus being able to provide an improvement in the quality of life and a more effective return to work training in patients with PD

The effects of graded motor imagery and its components on chronic pain: A systematic review and meta-analysis

This is the post-print version of the final paper published in The Journal of Pain. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2013 The American Pain Society.Graded motor imagery (GMI) is becoming increasingly used in the treatment of chronic pain conditions. The objective of this systematic review was to synthesize all evidence concerning the effects of GMI and its constituent components on chronic pain. Systematic searches were conducted in 10 electronic databases. All randomized controlled trials (RCTs) of GMI, left/right judgment training, motor imagery, and mirror therapy used as a treatment for chronic pain were included. Methodological quality was assessed using the Cochrane risk of bias tool. Six RCTs met our inclusion criteria, and the methodological quality was generally low. No effect was seen for left/right judgment training, and conflicting results were found for motor imagery used as stand-alone techniques, but positive effects were observed for both mirror therapy and GMI. A meta-analysis of GMI versus usual physiotherapy care favored GMI in reducing pain (2 studies, n = 63; effect size, 1.06 [95% confidence interval, .41, 1.71]; heterogeneity, I2 = 15%). Our results suggest that GMI and mirror therapy alone may be effective, although this conclusion is based on limited evidence. Further rigorous studies are needed to investigate the effects of GMI and its components on a wider chronic pain population.NHMR