Genetic, lifestyle and metabolic factors contributing to cardiovascular disease in the Italian population: a literature review

Cardiovascular diseases (CVD) represent a major health problem worldwide. In Italy, despite the decline in CVD mortality and disability-adjusted life years recently observed, CVD remains the leading cause of death. The development of CVD has a complex and multifactorial etiology that involves environmental, lifestyle/behavioral (e.g., unhealthy diet, physical inactivity, smoking, and alcohol abuse), metabolic, and genetic factors. Although a large number of CVD susceptibility genetic variants have been identified, some seem to confer risk according to the genetic background or ethnicity of the population. Some CVD-associated polymorphisms with appreciable frequency in the Italian population may be important contributors to the development and progression of the most prevalent CVD in the population. This literature review aims to provide an overview of the epidemiology of CVD in Italy, as well as to highlight the main genetic, lifestyle/behavioral, and metabolic factors contributing to CVD risk in this population.

Association of hospital/ICU characteristics with HAIs: findings from the SPIN-UTI project

Background

Preventing the spread of healthcare-associated infections (HAIs) in Intensive Care Units (ICUs) constitutes a priority for Public Health. In a country with decentralized healthcare system, the comparison between and within regions might represent a useful approach to identify what hospital and ICU indicators are associated with HAIs.

Methods

Using data from the SPIN-UTI (”Sorveglianza attiva Prospettica delle Infezioni Nosocomiali nelle Unità di Terapia Intensiva”) network, the present analyses aimed to identify the main hospital and ICU indicators associated with HAI incidence at national level, and to stratify the analyses between Italian regions.

Results

No associations between hospital/ICU characteristics and HAIs were evident at national level. However, ICUs in Southern Italy showed the highest incidence density of HAIs if compared with those in Central and Northern Italy (p < 0.001). Stratified analyses found a positive association of incidence density of HAIs and total days in ICU in Northern Italy (β = 0.3; SE = 0.1; p = 0.002); a positive associations with ICU size (β = 1.8; SE = 0.7; p = 0.020), total days in hospital (β = 0.06; SE = 0.02; p = 0.037) and total days in ICU (β = 0.5; SE = 0.1; p = 0.006) in Center Italy; a positive association with hospital size in Southern Italy (β = 20.3; SE = 9.4; p = 0.033).

Conclusions

Although our study confirms that HAIs still represent an important issue in Italian ICUs, there is some variation between regions from Northern, Central and Southern Italy. In general, we found that HAI incidence increased with increasing number of beds in hospital and in ICU, as well as with the the increasing number of patient-days. However, further research is necessary to better understand if additional hospital and ICU characteristics could motivate the observed regional differences.

Key messages

• There is a large regional variation in the incidence of HAIs in Italian ICUs and hospitals.

• This difference that could be motivated by specific hospital and ICU characteristics.

Categorical principal component analysis to characterize patients at Intensive Care Unit admission

Background

Healthcare-associated infections (HAIs) are the most frequent complications in healthcare settings, with a major impact on adverse outcomes. Here, we aimed to identify the relationships between patients’ characteristics admitted to Intensive Care Units (ICUs).

Methods

We used data of patients included in the “Italian Nosocomial Infections Surveillance in Intensive Care Units” (SPIN-UTI) project, who stayed in ICU for more than 2 days. Using Categorical principal component analysis (CATPCA) two components of risk were assessed. Values of variance accounted for (VAF) >0.3 were accepted as the significant effect of a variable on each component. A Chronbach’s alpha >0.7 was accepted as a measure of the internal consistency of the model.

Results

A total of 22402 admissions (62% female) were included. The average age was 65.7 years (SD = 16.6). Our model explains 35.3% of the total variability, with a Cronbach's alpha value of 0.847. The visual examination of component loading plot allows to evaluate the correlation between the quantified variables and each of the two components. In particular, the first component is explained by the presence of intubation (VAF=0.826), central venous catheter (VAF=0.749), and urinary catheter (VAF=0.727), patient’s origin (VAF=0.584), antibiotic treatment (VAF=0.479), non-surgical treatment for acute coronary disease (VAF=0.375), type of admission (VAF=0.509), surgical intervention (VAF=0.419). In the second component, the variables with the greatest contribution were the SAPS II (VAF=0.660), age (VAF=0.583), type of admission (VAF=0.531), surgical intervention (VAF=0.522). Thus, the first component would represent the exposure to invasive devices and medical procedures, and the second component the severity of patients.

Conclusions

Our results proposed the usefulness of CATPCA to identify factors involved in the development of adverse outcomes, highlighting the role of exposure to invasive devices and severity of patients.

Key messages

• There are several relationships between patients clinical and personal characteristics.

• CATPCA represents a useful approach for the analytical exploitation of healthcare data.

Comparison of Quantitative Real-Time PCR and Digital PCR to Detect the Polyomavirus in Merkel Cell Carcinoma

Merkel cell polyomavirus (MCPyV) prevalence in Merkel cell carcinoma (MCC) cases is controversial. The detection and quantification of MCPyV DNA is mainly performed by PCR techniques using formalin-fixed, paraffin-embedded (FFPE) tissues. The aim of this study is to compare the performance of two different molecular techniques, specifically the quantitative Real-Time PCR (qPCR) and digital PCR (dPCR). Samples from 31 cases of MCC excisional surgical biopsies were analyzed. DNA extraction and purification from clinical samples were performed using the QIAcube Qiagen automated nucleic acid extractor. After the extraction, MCPyV was detected by qPCR and dPCR using specially designed primers and probes. Of the 31 MCC samples under study, the MCPyV genome was detected in 11 samples (35%) by qPCR compared with 20 samples (65%) detected by dPCR. Notably, 65% of primary tumors were positive for MCPyV (15/23). The viral genome was detected in 75% of tumors located at UV-exposed sites (6/8), 55% of tumors at partially UV-protected sites (5/9), and 67% of tumors at UV-protected sites (4/6). Our results showed a better sensitivity of dPCR in detecting the MCPyV genome in MCC samples compared with traditional qPCR techniques.

Malassezia skin diseases in humans

Although Malassezia yeasts are a part of the normal microflora, under certain conditions they can cause superficial skin infection, such as pityriasis versicolor (PV) and Malassezia folliculitis. Moreover the yeasts of the genus Malassezia have been associated with seborrheic dermatitis and dandruff, atopic dermatitis, psoriasis, and, less commonly, with confluent and reticulated papillomatosis, onychomycosis, and transient acantholytic dermatosis. The study of the clinical role of Malassezia species has been surrounded by controversy due to the relative difficulty in isolation, cultivation, and identification. This review focuses on the clinical, mycologic, and immunologic aspects of the various skin diseases associated with Malassezia. Moreover, since there exists little information about the epidemiology and ecology of Malassezia species in the Italian population and the clinical significance of these species is not fully distinguished, we will report data about a study we carried out. The aim of our study was the isolation and the identification of Malassezia species in PV-affected skin and non-affected skin in patients with PV and in clinically healthy individuals without any Malassezia associated skin disease.

Favourable prognostic value of antibodies anti-HSP20 in patients with cystic echinococcosis: a differential immunoproteomic approach

Seeking biomarkers reflecting disease development in cystic echinococcosis (CE), we used a proteomic approach linked to immunological characterisation for the identification of respective antigens. Two-dimensional gel electrophoresis (2-DE) of sheep hydatid fluid, followed by immunoblot analysis (IB) with sera from patients with distinct phases of disease, enabled us to identify by mass spectrometry heat shock protein 20 (HSP20) as a potential marker of active CE. Using IB, antibodies specific to the 34 kDa band of HSP20 were detected in sera from 61/95 (64%) patients with CE, but not in sera from healthy subjects. IB revealed anti-HSP20 antibodies in a higher percentage of sera from patients with active disease than in sera from patients with inactive disease (81 vs. 24%; P = 10(-4)). These primary results were confirmed in a long-term follow-up study after pharmacological and surgical treatment. Herewith anti-HSP20 antibody levels significantly decreased over the course of treatment in sera from patients with cured disease, relative to sera from patients with progressive disease (P = 0·017). Thus, during CE, a comprehensive strategy of proteomic identification combined with immunological validation represents a promising approach for the identification of biomarkers useful for the prognostic assessment of treatment of CE patients.

Detection of Candida dubliniensis in oropharyngeal samples from human immunodeficiency virus infected and non-infected patients and in a yeast culture collection

The incidence of Candida dubliniensis in oropharyngeal swabs of 132 human immunodeficiency virus (HIV)-positive and 89 HIV-negative patients was determined. The samples were plated onto CHROMagar Candida medium and 82 strains, presumptively identified as C. albicans or C. dubliniensis, were further investigated (temperature test, chlamydoconidia production, specific primer PCR). In addition, 487 collection strains (isolated from clinical samples and previously identified as C. albicans on the basis of a positive germ tube test) were screened in order to identify C. dubliniensis isolates. Two C. dubliniensis strains were isolated from two HIV-positive patients without oral candidiasis. Candida dubliniensis was not isolated from 89 HIV-negative patients nor was it identified among the collection strains.

Use of magnetic beads to extract fungal DNA

Authors compare two methods of extracting DNA from different fungi: the classic method with phenol/chloroform (P/C) and that with magnetic beads. Both were tested on Candida albicans and Cryptococcus neoformans var. neoformans, belonging to the yeast group and Microsporum canis, M. gypseum, Trichophyton rubrum, T. interdigitale, T. ajelloi, Epidermophyton floccosum, belonging to the dermatophytes group. Extraction products underwent polymerase chain reaction (PCR) fingerprinting with the appropriate primers to point out any disagreement in the genomic profiles. After having determined that the genomic profiles obtained from the DNA extracted from the same strain with the two methods correspond perfectly, the authors concluded that the extraction method with magnetic beads from fungal cells is simpler and quicker than with P/C extraction, greatly facilitating the obtainment of fungal DNA.

Investigation in Central Italy of the possible association between Cryptococcus neoformans var. Gattii and Eucalyptus camaldulensis

The authors present a worldwide review of isolations of Cryptococcus neoformans, var. neoformans and C. neoformans var. gattii from animals and vegetation, referring in particular to the already well-known association of the former variety with Eucalyptus camaldulensis. They then review the Italian situation relative to this association and their studies carried out in Central Italy: in Latina (Lazio), Pisa, Viareggio and Lake Massaciuccoli (Tuscany). From the 256 E. camaldulensis trees examined C. neoformans var. gattii was not isolated. An E. camaldulensis tree situated in the nature reserve on Lake Massaciuccoli proved to be positive for C. neoformans var. neoformans. This variety was isolated from the leaves, flowers, bark and the debris at the foot of the tree, suggesting that it had colonized the entire tree and that it was capable of developing not only on its usual habitat (bird guano, soil rich with guano) but also on Eucalyptus trees. The identity of the isolates was confirmed by their genomic profiles obtained by random amplification polymorphic DNA (RAPD) with the primer (GACA)4. The presence of a single genotype indicates a sole source of contamination, perhaps brought by a bird coming from a contaminated environment.

Application of PCR to distinguish common species of dermatophytes

This report describes the application of PCR fingerprinting for the identification of species and varieties of common dermatophytes and related fungi utilizing as a single primer the simple repetitive oligonucleotide (GACA)(4). The primer was able to amplify all the strains, producing species-specific profiles for Microsporum canis, Microsporum gypseum, Trichophyton rubrum, Trichophyton ajelloi, and Epidermophyton floccosum. Intraspecific variability was not observed for these species. Instead, three different profiles were observed in the Trichophyton mentagrophytes group.

Anti-Malassezia furfur antibodies in the population

The authors carried out research into anti-Malassezia precipitating antibodies in the population, specifying the distribution by age and sex. A total of 868 serum specimens from subjects of both sexes, aged between 0 and 80 years, were studied. An immunoelectroprecipitation reaction was used using a M. furfur culture filtrate as antigen. No antibodies were found in children under 11 years, whereas they were present after that age and reached maximum frequency in subjects between 31 and 40 years of age. In subjects up to 50 years of age they were more frequent in women, but in subjects over the age of 50 years they were more frequent in men. Globally, antibodies were found in 31% (270/868) of the subjects examined. The presence of antibodies correlates with data from the literature regarding the isolation of this yeast in relation to age.

Scanning electron microscopic pattern of recurrent vaginitis by Candida albicans in the mouse

The scanning electron microscopic pattern of the development of yeasts of Candida albicans on the vaginal mucosa of mice in oestral phase, was studied in four consecutive infections performed at 30 d intervals. The findings were practically identical following the 1st and 2nd infections, evidencing a progressive mycelial development starting from 12 to 72 h after inoculation with C. albicans yeasts. In the 3rd and 4th infections the mycelial tufts appeared extremely reduced in number and size, although there was an acceleration in the early evolutive phases and the filamentation process had already started 6 h after infection. It can be concluded that, after successive infections with C. albicans, mouse vaginal mucous membrane develops a local state of resistance evidenced by the decrease in mycelial tufts. The possible causes of the early onset of the filamentation process are discussed.

[A case of mycotic endocarditis. Clinical, diagnostic and therapeutic considerations]

A case of endocarditis in 17 year old female with a psychomotor and neurovegetative disorder is presented. Serum and cultural data as well as the excellent response to treatment with 5-flucytosine seems to confirm the diagnosis of candida infection.

Fungal infections in hematological neoplastic disease: the possibility of chemoprophylaxis

Immunoelectrosmophoresis (IEOP) was used to detect antigens of Candida albicans in the sera of 90 patients with hemolymphoblastosis. A higher percentage of sensitive results occurred in patients with acute myeloid leukemia; moreover, most of the serologically positive patients showed severe leukopenia and neutropenia (WBC less than 1000/microliter; neutrophils less than 200/microliter). According to the results of IEOP assays, a prophylactic treatment with standard dosages of amphotericin B or myconazole was instituted in positive cases. Treatment schedules were randomized in order to assess the effect of each drug. The therapy resulted in serological negativity in 60% of the patients treated with amphotericin B and 57% of those who were given myconazole.