Frequent antibiotic prescriptions for urinary infections (UI) promote the development and spread of antibiotic resistance. In order to identify effective antibiotics for the first line treatment of UI at the Galaţi Infectious Diseases Hospital, we performed a retrospective study based on disk diffusion antibiotic sensitivity testing on bacterial strains from urine cultures. Urine samples were collected from hospitalized patients admitted with symptomatic UI during 2010. In total, 659 records were found of certified bacteriological UI, of which 82% were caused by Enterobacteriacea. Escherichia coli isolates were the most commonly encountered species of Enterobacteriaceae (83%). The median age of the patients with urinary E. coli was 48 [3; 87], sex ratio M/F= 56/399 and 9.8% of patients were HIV positive. Using the Carmeli scoring system for antibiotic resistance risk, we found that 86% of the E. coli isolates were community acquired infections. High level of resistance was evident for Ampiciline at 85%, Neoxazole at 54,6%, TMP-SMX at 45,6% and AmoxiClavulanate at 40,2%. The best sensitivity was obtained with 3rd generation cephalosporins and carbapenemes. The incidence of ESBL-positive strains was 7.4% (34/421). No ESBLpositive strain was identified in community acquired UI (Carmeli score 1). In conclusion, it is strongly recommended that the first line of antibiotic therapy at the Gala ţi Infectious Diseases Hospital should involve 3rd generation cephalosporins, while carbapenems should be reserved to patients with a Carmeli score of 2 or 3.
Nicotinic acetylcholine receptors (nAChRs) are ligand-gated ion channels present in many regions of the central nervous system (CNS) and the peripheral nervous system. The neuronal nicotinic acetylcholine receptors, being situated at the level of different neurotransmission pathways, participate in the function of many cerebral activities.
Consequently, qualitative or quantitative deficits of nicotinic receptors are responsible for dysfunctions of these brain activities; such dysfunctions can occur at different stages of life due to brain aging or numerous neurological and psychiatric diseases of the developmental age, adulthood and old age. Modifications of specific nAChR subtypes have been found localized in specific brain regions in each such disorder.
In this review, we will discuss some of the above-mentioned brain disorders, reporting the relevant nAChR changes discovered to date, and summarize the therapeutic prospects currently under development.
Palliative procedures are those usually used in the treatment of metastatic limb sarcoma. However given the impressive results obtained with hyperthermic isolated limb perfusion (ILP), we tested the feasibility of isolated lung perfusion (ILuP), using the same regimen. Three patients with multiple metastases from limb sarcoma were included in this study.
ILP was applied in one patient resulting in limb preservation. Patients underwent 90minute ILuP, and subsequent metastasectomy. In all cases the procedure was completed without complications. No systemic toxicity developed. The only postoperative complication was one case of reversible interstitial and alveolar lung edema. The three patients are still alive and two of them were disease-free at a mean follow-up of 19 months. ILuP, with TNF and Melphaln, proved to be feasible and safe. This technique, in association with ILP, might improve long-term survival and quality of life in patients with multiple metastases from limb sarcoma.
This article presents the case of a 26 year old male heroin addict and chronic user of high doses of citalopram, who was found dead at his home. Toxicological analysis showed that the young man was in a state of chronic citalopram intoxication. The low opioid concen-tration detected excluded heroin overdose as the cause of death.
The heroin used by the man was characterized by a low percentage of opiates (heroin 0.1%, acetylcodeine 0.8%; 6-MAM 1.19%, codeine 0.2%) and a high percentage of cutting substances (caffeine 38%, acetaminophen 29%).
The pathogenetic mechanism underlying the man’s death was reconstructed through the integrated evaluation of analytical and pathological data together with consideration of the toxic effects of intravenous injection of heroin cut with a significant amount of caf-feine (although non-lethal) in the presence of high citalopram concentrations.
This study is a retrospective work of ambulatorial injections in patients suffering from Class II osteoarthritis (OA) of the knee. The research was conducted from January 2012 to July 2012 in a private clinic in Benevento, Hospital Val D'Elsa, Poggibonsi, Siena. A total of 60 patients were treated with intraarticular knee injections. Group A, composed of 30 patients (15 male and 15 female), was treated with injections of low molecular weight Hyaluronic Acid and Group B, composed of 30 patients (15 male and 15 female) was treated with injections of Ploynucleotide. At the six month follow-up, Group B showed a statistically significant difference (p<0.05) of the Visual Analogue Scale (VAS); the Knee injury and Osteoarthritis Outcome Score for Group B also showed a statistically significant difference (p<0.05). The results obtained suggest that polynucleotides can be considered as a valid alternative to hyaluronic acid for the treatment of symptomatic osteoarthritis of the knee.
The purpose of this study was to evaluate the different behaviors of the femoral bone in patients after anterior cruciate ligament reconstruction. Twenty-two patients undergoing ACL reconstruction either by double semitendinosus and gracilis tendon graft (DTSG), or ligament advanced reinforcement system (LARS) fixed at the femur with two biodegrad-able pins (RIGID FIX), were evaluated.
In all patients a physical examination was performed and functional outcome scores were obtained at follow up. Instrumental evaluation was performed by multislice CT. The CT scan, which mainly focused on the area of the femoral tunnel, showed an increase in spongy bone out of the socket in the surgery performed with LARS, while in patients treated with DTSG, the bone retained the normal structural characteristics of density of the femoral meta-epiphysis. The CT scan also documented a higher rate of pin biodegra-dation in reconstruction with LARS. The results analysis showed different patterns of re-sponse based on the type of ligament. A bone reaction for mainly mechanical purposes, evidenced by a circumferential fibrous ring, was observed in all patients. Additionally, a bone reaction for biological purposes, characterized by an increase in the spongy tissue associated with a reduction in bone density and a faster reabsorption of pins, was found in patients treated with LARS.
Efforts in developing guidelines have to be supported by investments on their application. Medical software may have a role in these initiatives. Two computer programs have been developed: one regarding chronic kidney disease and one about chronic pain management. For six months their use by 104 general practitioners was monitored. At study conclusion, a questionnaire of 13 multiple choice questions was emailed to all participating doctors. To evaluate the clinical benefits for the patients, a GP regularly used the CKD program and provided patients’ outcomes and clinical data. The application recorded 108 accesses during 66 work sessions. In the clinical outcomes section of this study, 7 patients out of 21 were diagnosed with CKD. Our study shows a need for programs of the “expert systems” kind: sources devoted to a narrow field of competence, accessed only when needed, in a way that resembles traditional specialist consultation.
In the contemporary society an International Health Elective (IHE) represents a strategic tool in order to implement future medical doctor’s education. In Italy, in the last decade, an increasing interest of trainees and residents to IHE and opportunities was documented and supported by the reorganization of the Italian residency programs, provided by the Ministry for Education, University and Research (MIUR). Aim of the present study was to collect data on perceived need of medical residents for an IHE.
A structured questionnaire was developed and administered to medical residents of Palermo’s University who underwent their annual visit to the Occupational Health Physician Ambulatory (OHPA) of Palermo’s University Hospital, in the period between March and October 2011.
Medical residents more prone to undergo an IHE were, younger than 29 years old (p <0.01), attending the new educational system (p 0.02) and surgical residents (p= 0.0001). A negative opinion about the formative quality performances of the residency program was significantly associated with surgical residencies (p= 0.002). Future Italian surgeons are more prone to undergo an IHE and this statement is probably related to the not satisfying residency program. Residents attending the old educational system consider the IHE as a way to implement their professional perspectives possibly for their more realistic professional perspective facing an approaching future full of work uncertainties.
Considering the future competition between medical professionals working in different EU contexts, the Italian Government should implement future medical education policy in order to provide for a Healthcare “without Border” in the EU.
Many peptides are present in the nasal mucosa, but few studies have investigated the presence or absence of the oxytocin and vasopressin peptides. This immunohistochemical study on the inferior turbinates of patients affected by chronic sinusitis shows, for the first time, that these peptides are present in the epithelium of both nasal mucosa and glands. Their presence could be related to the presence of atrial natriuretic peptide (ANP), like previously demonstrated in other organs such as heart and prostate, since in some circumstances they play in antagonism.
In this article we have reviewed the main risk factors for this disease in particular: sun exposure, the use of tanning beds or sunlamps and skin phototype.
We also mention the importance of primary prevention in subjects at risk to reduce the onset of cutaneous melanoma.
Phalloplasty procedures for most men requiring penile augmentation surgery are cos-metic procedures; generally the patients have a normal-sized and fully functional penis but they think that their penis is too small. There are not well defined indications for penile enhancement surgery and, except for the treatment of "micropenis", there are not established guidelines and the outcome measures for success are still unclear. All penile enhancement techniques often do not reach the expected result and the grade of pa-tient’s satisfaction is frequently poor. Phalloplasty procedures for psychological dys-morfism are not approved by any scientific society and the majority of these procedures are performed in private settings. The ethical and medicolegal problems resulting from a penis enhancement can be various and numerous, but few of them are reported in litera-ture. After phalloplasty an attribution of professional responsibility and request of reim-bursement is not rare. In this contribution the authors summarize a panorama of several urological and medico-legal aspects related to phalloplasty procedures.
In the past few years, contributions of molecular biology assays to the investigation of sudden juvenile death have permitted to clarify some of the pathogenetic aspects of sud-den arrhythmic death, opening the way to preventive action on victims’ relatives.
We reviewed literature on the genetics of sudden juvenile death, and on molecular biol-ogy assays performed on autoptic samples.
Biological investigation permits the detection of genetic mutations underlying the suscep-tibility to sudden cardiac death of individuals with rare inherited forms of arrhythmia (Long QT Syndrome, Brugada Syndrome, Lev’s disease etc.) through the analysis of criti-cal sequences codifying for ion channel subunits (HERG, KvLQT1, MinK, Mirp1, SCN5A, KCNQ1, KCNH2, KCNE1, KCNE2).
The main objective of post-mortem investigation in sudden juvenile death is the detection of treatable monogenic inherited disorders, in order to prevent further deaths among the relatives of the deceased patient.