Diagnosis and characterization of viral infections of the central nervous system

Viral infections of the central nervous system (CNS) are underdiagnosed and their etiology often unknown. To increase case finding and etiologic diagnosis, patients with at least two symptoms among which fever, headache, impaired consciousness, focal signs and neck stiffness entered a diagnostic algorithm, including risk factors, epidemiological, clinical, laboratoristic and radiological criteria. A check list of serologic and molecular virology tests to be performed on blood and cerebrospinal fluid was developed. Tests were performed following a priority algorithm. The study was conducted in the 2012-2014 period and data were compared with what was found in the 2009-2011 period. In the 2012-2014 period, 34 cases of suspected viral infection of the CNS were identified. Viral etiology was confirmed in 21/34 (61.7%). In the 2009-2011 period, 27 cases of suspected viral infection of the CNS were identified. Viral etiology was confirmed in 10/27 (37.0%). Overall, in the 2009-2014 period, 61 cases have been diagnosed. Males were 34/61 (55.7%), mean age was 50.2 (range 18-85). Etiology was established in 31/61 (50.8%) as follows: VZV 9 cases, Toscana Virus 6, HSV 1 6, HSV 2 and Enterovirus 3, West Nile 2, HHV 7 and parvovirus B19 one. When lumbar puncture was performed within 72h from the onset of symptoms, an etiologic diagnosis was made in 15/27 cases (55.5%); when lumbar puncture was performed after 72h from the onset of symptoms, an etiologic diagnosis was made in 10/28 cases (35.7%). At CSF examination, leukocytes count was increased (>5x109/L) in 59/60 (98.3%) and lymphocytes were prevalent in 57/60 (95.0%); glucose was reduced (60 mg/dl) in 40/60 (66.6%). Overall mean CSF leukocytes count was 280x109/L while mean leukocytes count of Enterovirus infections was 151x109/L and that of VZV infections was 625x109/L. Mean protein concentration was 110 mg/dl while that of VZV infections was 237.9 mg/dl. Additionally, a seroprevalence survey for Toscana Virus was conducted on consecutive patients admitted in the Infectious Diseases Unit, regardless the symptoms: IgG or IgM were positive in 34/100 cases (34%), with a clear trend to increase with age

Computational Intelligence Methods for Bioinformatics and Biostatistics : 10th International Meeting, CIBB 2013, Nice, France, June 20-22, 2013, Revised Selected Papers

International audienc

Appropriateness and cost-effectiveness in the treatment of invasive candidiasis in Internal Medicine Wards

Invasive candidiasis (IC), including candidemia, is a major cause of morbidity and mortality among patients and the majority of cases of candidemia are documented in Medical Wards. Early identification of patients at risk, knowledge of local epidemiology and prompt efforts to define etiologic diagnosis are pivotal to ensure appropriateness. Start with an echinocandin and switch to fluconazole when possible, seems to represent a useful strategy for the management of IC. The choice between the three echinocandins should be based on the specific indications, pharmacokinetic/pharmacodynamic profile, clinical experience and cost

Long-term, low-dose tigecycline to treat relapsing bloodstream infection due to KPC-producing Klebsiella pneumoniae after major hepatic surgery

Summary A 68-year-old male underwent a right hepatectomy, resection of the biliary convergence, and a left hepatic jejunostomy for a Klatskin tumour. The postoperative course was complicated by biliary abscesses with relapsing bloodstream infections due to Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp). A 2-week course of combination antibiotic therapy failed to provide source control and the bacteraemia relapsed. Success was obtained with a regimen of tigecycline 100mg daily for 2 months, followed by tigecycline 50mg daily for 6 months, then 50mg every 48h for 3 months. No side effects were reported

Aluminizing via Ionic liquid electrodeposition and pack cementation: A comparative study with inconel 738 and a CoNiCrAlY

A novel aluminizing process based upon room temperature Al-electrodeposition from Ionic Liquids followed by diffusion heat treatment was applied on bare- and CoNiCrAlY-coated Inconel 738 (IN738). The aluminized samples were tested by isothermal oxidation at 1000 °C in air. The microstructural and chemical evolution of the samples were determined as function of oxidation time and compared with the currently applied coatings obtained via pack cementation. The newly proposed method is suitable for the CoNiCrAlY coating, but not for the bare IN738. In the latter, the formed Al-enriched layer is much thinner and the anticorrosion properties resulted in being reduced. This is probably due to the presence of precipitates, which slow down the aluminum inward diffusion impairing the formation of a well-developed interdiffusion zone (IDZ). Traces of the electrolyte, embedded during the Al-electrodeposition process, can be seen as the origin of these precipitates

Observation of single phonon-mediated quantum transport in a silicon single-electron CMOS transistor by RMS noise analysis

We explore phonon-mediated quantum transport through electronic noise characterization of a commercial CMOS transistor. The device behaves as a single electron transistor thanks to a single impurity atom in the channel. A low noise cryogenic CMOS transimpedance amplifier is exploited to perform low-frequency noise characterization down to the single electron, single donor and single phonon regime simultaneously, not otherwise visible through standard stability diagrams. Single electron tunneling as well as phonon-mediated features emerges in rms-noise measurements. Phonons are emitted at high frequency by generation-recombination phenomena by the impurity atom. The phonon decay is correlated to a Lorentzian $1/f^2$ noise at low frequency.Comment: 5 pages, 3 figures, submitted to AP

A workflow to generate physical 3D models of cerebral aneurysms applying open source freeware for CAD modeling and 3D printing

Objectives: 3D anatomical models are becoming a new frontier in surgery for planning and simulation on an individualized patient specific basis. Since 1999, 3D cerebral aneurysms models for neurosurgery have been proposed. The possibility of reproducing in a realistic 3D fashion the malformation with the surrounding vascular structures, provides important preoperative information for the treatment strategy. The same models can be used for training and teaching.Unfortunately stereolitography is often burdened by high costs and long times of production. These factors limit the possibility to use 3D models to plan surgeries in an easy daily fashion. Patients and methods: Our study enrolled 5 patients harboring cerebral aneurysms. DICOM data of each aneurysm were elaborated by an open source freeware to obtain CAD molds. Afterwards, the 3D models were produced using a fused deposition or a stereolitography printer. Results: Models were evaluated by Neurosurgeons in terms of quality and usefulness for surgical planning. Costs and times of production were recorded. Conclusions: Models were reliable, economically affordable and quick to produce. Keywords: Stereolitography, Cerebral aneurysms, 3D printing, Surgical planning, Aneurysm model

Hepatic abscess caused by trans-gastric migration of a fishbone

Background Stomach or duodenal perforation due to foreign body are usually associated with the development of a walled-off abdominal mass or abscess, and are less prone to cause systemic signs of infection. Methods and Case presentation A 65-year-old man with no comorbidities was admitted for rapid onset of abdominal discomfort, fever, and chills. An abdominal computed tomography (CT) showed an 8 cm abscess in the left lobe of the liver. The lesion was aspirated under ultrasound guidance; cultures from the abscess grew Streptococcus constellatus. Chest CT scan, colonoscopy, esophagogastroduodenoscopy, and blood cultures were negative. The patient’s clinical status rapidly improved with antibiotic therapy, but a follow-up CT scan revealed the presence of a thin, 3 cm-long radiopaque object at the site of the previous abscess. A few months later, due to symptomatic cholelithiasis, the patient underwent elective laparoscopic cholecystectomy and concurrent removal of a 3 cm-long fishbone, which was embedded into the wall of the gastric antrum and the third segment of the liver, the latter which was partially resected. Results The small gastrotomy was reapproximated with a single resorbable stitch. The post-operative course was uneventful and at 6 month follow up, the patient was asymptomatic without evidence of residual abdominal pathology. Conclusions Asymptomatic perforation of the gastric wall by an ingested foreign body can occur and be subsequently complicated by a liver abscess. A contained perforation can be successfully managed conservatively

Treatment of locally advanced and metastatic basosquamous carcinoma, navigating among sonic hedgehog pathway inhibitors, immune checkpoint inhibitors, chemotherapy, and radiotherapy: A case series and literature review

Locally advanced (laBSCs) and metastatic basosquamous carcinomas (mBSCs) represent a therapeutic challenge. By definition, these forms are not amenable to surgery or radiotherapy, but according to literature reports, sonic hedgehog pathway inhibitors (HHIs), anti-programmed death 1 receptor antibodies (anti-PD-1), and other treatment approaches involving chemotherapy, surgery, and radiotherapy have been used. This work features 5 real-life cases of advanced BSCs, treated at the Dermato-Oncology Unit of Trieste (Maggiore Hospital, University of Trieste). In addition, a review of the current treatment options reported in the literature for laBSC and mBSC is provided, collecting a total of 17 patients. According to these preliminary data, HHIs such as sonidegib and vismodegib could represent a safe and effective first line of treatment, while the anti-PD-1 cemiplimab may be useful as a second-line option. Chemotherapy and combined approaches involving surgery and radiotherapy have been also reported to be suitable in some patients

Fungicidal activity and PK/PD of caspofungin as tools to guide antifungal therapy in a fluconazole-resistant C. parapsilosis candidemia

Candida parapsilosis may be responsible for bloodstream infections (BSI) and it is characterised by an increased incidence of fluconazole resistance. A 75-year old woman with severe comorbidities received the insertion of a peripherally inserted central venous catheter. Fluconazole did not prevent a C. parapsilosis BSI hence caspofungin was started after a nephrotoxic first-line treatment with amphotericin B. The ratio of peak plasma concentration over the minimum inhibitory concentration (Cmax/MIC) was adopted to maximise efficacy of caspofungin. MIC and plasma Cmax values were obtained by broth microdilution and LC-MS, respectively. Interestingly, daily doses of 1 mg/kg (total daily dose, 50 mg) allowed the achievement of Cmax/MIC values > 10. The optimised regimen was safe and effective, leading to negative blood culture at day 8. The patient was discharged home at day 21. Therefore, individualised dosing regimens of caspofungin may be effective and safe even in the case of C. parapsilosis BSI