A Southern addiction evaluation project: investigating the impact of addiction through a survey HBSC based

Background

Adolescence is a critical phase of development characterized by numerous physical, psychological and social changes. During this stage, individuals may engage in experimentation and risky behavior, leading to increased vulnerability to addiction. This article aims to present the results of a survey based on the HBSC (Health Behavior in School-aged Children) surveillance model in a province of Southern Italy for primary and secondary school students.

Methods

We conducted a prospective study from March 2020 to April 2023 through the administration of a questionnaire to students of the healthcare faculties of the University of Messina and primary and secondary school students, composed of 19 items and based on HBSC surveillance.

Results

We collected a total of 664 questionnaires. We found that smoking habits increase with age: approximately 31% of secondary school students declare they are real smokers compared to 40% of HCP students. At least once, in the three study groups, students experienced alcohol consumption at different rates, with younger students having a greater propensity to drink than older students. Fortunately, in our sample, no middle school students had tried cannabis. At the same time there is a surprising decrease in gambling in all categories compared to national data.

Conclusions

The presence of addictive behaviors in our sample was found to be widespread despite being in line with the national trend. Furthermore, we have observed a reduction in recent years which needs to be investigated to assess the reasons. Primary prevention is probably the main weapon in the hands of politicians and must be applied early in school and community settings to reduce prevalence.

Study-related stress, perceived stress and quality of life among healthcare university students

Background

Many studies have shown that the stress level among healthcare university students is often as high as in workers who experience burnout. Our study investigated if it is possible to observe the burnout syndrome in these kind of students, able to significantly alter the quality of life, their approach to daily activities and relationship life.

Methods

The study was conducted through the administration of an anonymous questionnaire, distributed online through messaging apps, during the breaks between lessons. It was formulated using the perceived stress scale (PSS) in its short formula in order to evaluate feelings and thoughts and the WHOQOL-AGE, in order to evaluate the quality of life.

Results

The sample consisted of 292 university students aged between 18 and 49, with an average age of 22,42 ± 4,65. 16.4% does not often feel able to control the important things in life, 42.8% is often unable to manage personal problems. The PSS score of all our university students showed a high stress level in 6.2%, an average stress level in 57.2% and low stress level in 36.6%. The WHOQOL score shows that 42% had a high quality of life and only 4% had a poor quality of life, 54% had an intermediate quality of life and half of the sample was unsatisfied with the way he felt every day.

Conclusions

Many students (63.4%) are subjected to stress study-related, even if does not affect their quality of live, therefore not perceiving it as negative. There is a gender difference: females have a higher level of stress than men. Two thirds of the sample has an average or high stress level; only a third has a low grade. Stress prevention in young university students must begin through a new way of teaching, even if a certain amount of stress study-related is stimulant.

Adipose-Derived Mesenchymal Stromal Cells: A Tool for Bone and Cartilage Repair

The osteogenic and chondrogenic differentiation ability of adipose-derived mesenchymal stromal cells (ASCs) and their potential therapeutic applications in bone and cartilage defects are reported in this review. This becomes particularly important when these disorders can only be poorly treated by conventional therapeutic approaches, and tissue engineering may represent a valuable alternative. Being of mesodermal origin, ASCs can be easily induced to differentiate into chondrocyte-like and osteocyte-like elements and used to repair damaged tissues. Moreover, they can be easily harvested and used for autologous implantation. A plethora of ASC-based strategies are being developed worldwide: they include the transplantation of freshly harvested cells, in vitro expanded cells or predifferentiated cells. Moreover, improving their positive effects, ASCs can be implanted in combination with several types of scaffolds that ensure the correct cell positioning; support cell viability, proliferation and migration; and may contribute to their osteogenic or chondrogenic differentiation. Examples of these strategies are described here, showing the enormous therapeutic potential of ASCs in this field. For safety and regulatory issues, most investigations are still at the experimental stage and carried out in vitro and in animal models. Clinical applications have, however, been reported with promising results and no serious adverse effects.

Orobanche crenata Forssk. Extract Affects Human Breast Cancer Cell MCF-7 Survival and Viral Replication

BACKGROUND

Breast cancer (BC) is the leading cause of death worldwide. The severity of BC strictly depends on the molecular subtype. The less aggressive hormone-positive subtype is treated with adjuvant endocrine therapy (AET), which causes both physical and psychological side effects. This condition strongly impacts the adherence and persistence of AET among oncologic patients. Moreover, viral infections also constitute a serious problem for public health. Despite their efficacy, antiviral agents present several therapeutic limits. Accordingly, in the present work, we investigated the antitumor and antiviral activities of Orobanche crenata Forssk. (O. crenata), a parasitic plant, endemic to the Mediterranean basin, traditionally known for its beneficial properties for human health.

METHODS

The MTT assay was carried out to evaluate the cytotoxic effect of O. crenata leaf extract (OCLE) on human breast cancer cells (MCF-7 and MDA-MB-231) and the primary HFF-1 cell line. The lactic dehydrogenase (LDH) assay was performed on MCF-7 cells to analyze necrotic cell death. The antioxidant effect of OCLE was evaluated by intracellular determination of the reactive oxygen species and thiol groups, by DPPH and ABTS assays. The antiviral activity of OCLE was determined against Poliovirus 1, Echovirus 9, Human respiratory syncytial virus, Adenovirus type 2 and type 5, Coxsackievirus B1 (CoxB1) and B3 (CoxB3), Herpes simplex type 1 (HSV-1) and type 2 (HSV-2), and β-Coronavirus by the plaque reduction assay.

RESULTS

The extract, after 24 h of incubation, did not affect MDA-MB-231 and HFF-1 cell viability. However, at the same time point, it showed a dose-dependent inhibitory effect on MCF-7 cells, with an increase in LDH release. OCLE exhibited free radical scavenging activity and significantly increased non-protein thiol levels in MCF-7 cells. OCLE effectively inhibited HSV-1, HSV-2, CoxB1, and CoxB3 replication.

CONCLUSIONS

The overall results showed an interesting inhibitory effect of OCLE on both MCF-7 cell survival and viral replication.

Anti-Candidal Activity of the Parasitic Plant Orobanche crenata Forssk

Candida albicans (C. albicans) and Candida glabrata (C. glabrata) are part of the human microbiome. However, they possess numerous virulence factors, which confer them the ability to cause both local and systemic infections. Candidiasis can involve multiple organs, including the eye. In the present study, we investigated the anti-candidal activity and the re-epithelizing effect of Orobanche crenata leaf extract (OCLE). By the microdilution method, we demonstrated an inhibitory effect of OCLE on both C. albicans and C. glabrata growth. By crystal violet and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, we showed the ability of OCLE to inhibit the biofilm formation and the viability of yeast cells, respectively. By germ tube and adhesion assays, we proved the capacity of OCLE to affect the morphological transition of C. albicans and the adhesion of both pathogens to human retinal pigment epithelial cells (ARPE-19), respectively. Besides, by MTT and wound healing assay, we evaluated the cytotoxic and re-epithelizing effects of OCLE on ARPE-19. Finally, the Folin-Ciocalteu and the ultra-performance liquid chromatography-tandem mass spectrometry revealed a high content of phenols and the presence of several bioactive molecules in the extract. Our results highlighted new properties of O. crenata, useful in the control of Candida infections.

"Vaccinate your child for best protection": attitude towards vaccination in a group of pregnant women

BACKGROUND

Although the benefits and importance of vaccination before and right after pregnancy, are well known, vaccination coverage among pregnant women remains very low. The aim of our study was to evaluate pregnant women's knowledge and attitude towards vaccination.

STUDY DESIGN

A cross sectional study was performed from October 2018 to June 2019 at the University of Messina.

METHODS

We gave pregnant women >18 years old a non-self-compiling paper questionnaire. We stratified the sample according to age (<30 and >30 years old), marital status (single/divorced, in a relationship and married) and level of education (<8 and >8 years of school attendance). All possible correlations between collected data were analysed using software R.

RESULTS

The sample included 156 women (mean age 32±0.49 years old). Only 1.4% of the subjects were aware of all the vaccines indicated for children. Luckily, 86.7% of the sample had a positive attitude, believing in the effectiveness and safety of immunization, despite a limited lack of confidence and a belief in false myths was expressed by some of the subjects. Interestingly, results showed that information about vaccination were more frequently obtained from family/friends (52.6%), mass media (49.1%), blogs/forums (19.3%), rather than from medical institutions (only 17.5%) or the family physician (only 35.0%), reflecting the quality of the information obtained.

CONCLUSIONS

Our results proved that a general positive attitude emerged among our sample towards vaccination, however, correct information was not always provided to women, making it a crucial issue for public health in the future.

Adherence to the three Italian screening in a sample of women (and men) in the Southern Italy

INTRODUCTION

Although scientific evidence shows the numerous benefits of screening programs, in Italy. There is a great disparity between the regional coverage of the North and South despite the screening programs have been activated for several years in all regions even with territorial differences.

OBJECTIVE

The aim of our study was to evaluate the knowledge and adherence to different screenings in the population, the influence exercised by the local health authority the role of the general practitioner in advising and referring patients to screening tests and the main causes of refuse.

MATERIAL AND METHODS

The study was carried out, from December 2019 to May 2020, through the administration of anonymous self-filled "ad hoc" questionnaires to women and men over 26 years old.

RESULTS

in our sample 36% have never performed a breast check and 39% of the interviewees never had a mammogram; for cervical cancer 25% did not ever perform screening and 65% did not have an indication by GP. The worst result was found for colorectal cancer (only 27% of the sample performed the screening). The role of GP was fundamental for and similar to other studies, was fundamental in fact,similar to other studies the most frequent reported reasons for the non-execution of screening were the lack of physicians' advice, follwed by lack of time, the most frequent reported reasons for the non-execution of screening were the lack of physicians' advice, a lack of time, fear of cancer and embarrassment at visiting a gynaecologist.

DISCUSSION AND CONCLUSIONS

the study carried out found that despite the knowledge of the oncological disease and the possibilities of prevention is fairly rooted in the population, adherence to the screening is quite inadequate, especially as regards colorectal cancer.

Mediterranean diet: knowledge and adherence in Italian young people

INTRODUCTION

In November 2010 the Mediterranean Diet was recognized by the UNESCO as Intangible Cultural Heritage of Humanity. It is an heritage that brings together the dietary habits of the peoples of the Mediterranean countries, consolidated over the centuries remained almost unchanged until the 1950s. Numerous scientific studies have also shown that the Mediterranean Diet is an healthy diet that helps to prevent the main chronic diseases such as cardiovascular diseases, diabetes, bulimia and obesity and thanks to the antioxidant power of olive oil combined with vegetables consumption, an important means of cancer prevention. The aim of our study was to investigate the knowledge and the adherence to the Mediterranean diet of young people living in the Mediterranean area.

MATERIALS AND METHODS

The survey was carried out by administering a web-based anonymous questionnaire from March to May 2019 to Italian young people. In this survey we asked for socio-economic conditions, knowledge, awareness and adherence to the Mediterranean diet (through the KIDMED test) both in childhood and at present time. Parental educational status and family income were used as indicators of socio-economic status (SES).

RESULT

The sample was made up by 507 Italian young people between the ages of 17 and 35 (123 males and 384 females), with an average age of 22.88 years (DS 7.02). Only 11.4% knew the Mediterranean diet. During childhood 70.8% of respondents had breakfast and 58% ate fruit and vegetables daily. Today they have maintained the correct eating habits, in fact, 71.2% had breakfast, 60.2% ate fruit and 64.7% ate vegetables. In addition, only 48.3% eat fish and the majority of respondents consume carbohydrates (76.9%). To a lesser extent they consume junk foods like candy and various snacks (18.1%) or fast food meals (9.1%). Moreover, we asked for physical activity and we found that 48.9% did it. We found age, exercise and sex high significant variables (p<0.01). Higher adherence to MD was found in older interviewees.

CONCLUSION

Our study we found high knowledge to a Mediterranean diet into 90.5% of the sample and poor adherence into 23.5% of them, medium into 53.4% while higher only in 23.1% of the interviewees. Lower adherence was found among those who do not engage in physical activity and the two regressor with higher weight on the adherence to MD were "eat at home "and "eat fruit and vegetables". Furthermore, in our sample more increased the age more increased adherence to traditional diet models.

The double effect of walnut septum extract (Juglans regia L.) counteracts A172 glioblastoma cell survival and bacterial growth

Walnut (Juglans regia L.) is considered to be a 'superfood' for its multiple protective actions on human health. Walnut extracts have proven antitumor activity in different cancer cell lines. However, the efficacy of septum extract against glioblastoma has still not been investigated. Glioblastoma is the most difficult type of brain cancer to treat. The standard therapy, based on temozolomide, causes several side effects, including neutropenia and lymphocytopenia, which often favor the onset of opportunistic infections. In the present study, the chemical profile of the Sicilian walnut septum ethanolic extract was analyzed using high-performance liquid chromatography (HPLC)-diode array detection and HPLC-electrospray ionization tandem mass spectrometry. The potential cytostatic activity of the extract against the human A172 glioblastoma cell line was investigated and the results showed that the extract could decrease cancer cell proliferation and migration. Using cytofluorimetric analyses and caspase-3 assays, the pro-apoptotic action of walnut extract was demonstrated. Furthermore, the evaluation of the antibacterial activity high-lighted the efficacy of the extract in reducing Gram-positive and Gram-negative bacterial growth, most of which were resistant to the antibiotic, ciprofloxacin. Finally, Prediction of Activity Spectra for Substances analysis showed the predicted antitumor and antibacterial activity of HPLC detected compounds. The promising results could provide novel perspective in the field of chemotherapeutic co-adjuvants.

Definition of a novel vaccination pathway in PLWHA: experience of a Southern University Hospital

Background

At the end of 2018 across the globe there are ∼37.9 million people with HIV/AIDS also thanks to the use of HAART which led to an increase in life expectancy. The Italy Immunization Plan 2017-19 recommend vaccines to these patients but a protocol still isn't present. Moreover, despite the availability of effective vaccines, coverage remained very low for many reasons including problems with privacy. The objectives of this study were a) the appliance of a shared clinical pathway between the “Immunization Center of Hospital Hygiene Operating Unit” and the “HIV/AIDS Disease Prevention, Diagnosis and Treatment Center of Infectious Diseases Operating Unit” b) the increase in vaccination coverage and the evaluation of side effects.

Methods

A prospective study was conducted from Oct 2019 to Feb 2020 at the G. Martino University Hospital of Messina. In particular, of the 138 patients followed by the Infectious Diseases OU, after evaluation of their immune status, 62% were enrolled in this study. Following the acquisition of informed consent, we collected socio-anagraphical data and we started the free administration of vaccines by providing an hoc calendar in the Immunization Center. Statistical analysis was performed with R software.

Results

The sample was represented by 86 patients (74% males and 26% females, 21% foreigners and 79% Italian, mean age=40±13.6 SD). We didn't observe drop out and no differences were observed for local/systemic AEs generally reported. We obtained an increase of vaccination coverage with a total of 74 doses administered for flu (+164%) and 240 for other vaccines (+172%). In particular, we immunized a total of 74% of patients for HPV (2% in 2018), 42% for HAV (28% in 2018), 37% for HBV (28% in 2018), 58% for pneumococcal (21% in 2018), 54% for meningococcal ACWY and B (0% in 2018).

Conclusions

The undertook clinical pathway showed the relevance of specific management of these patients and the need to increase the vaccination offer.

Key messages

The immunization in people living with HIV is priority to reduce the risk of infectious disease. It’s important to implement a shared clinical pathway to increase vaccination rates of these patients. The application of the protocol had an high impact in patients' adhesion to vaccination also thanks to the chance of accessing to the service in a comfortable setting and suitable to protect privacy.

The role of water distribution system in HCAIs

Introduction

The water distribution system in hospitals may constitute a source of healthcare-associated infections. Understanding the means of acquisition, sources and reservoirs of nosocomial pathogens is crucial for developing methods to reduce the incidence of nosocomial infections. The aim of our study was to evaluate the microbiological contamination by Pseudomonas aeruginosa in the water system of the University Hospital “G. Martino” in Messina over a period of nine years, in order to a) clarify possible relationship between the presence of aerators and contamination, b) to highlight the presence of a yearly variation and c) to verify the statistical difference between microbiological contamination of taps with and without filters.

Materials and

Methods

We carried out a retrospective study for nine year through the collection of water samples that were analysed for total bacteria count and Pseudomonas aeruginosa. The differences between the results recorded over the nine-year study period were evaluated using variance analysis. P values of &lt; 0.05 were considered statistically significant. Software R was used for statistical assessment.

Results

We analysed a total of 6168 samples with a positive rate of 9.31% and a decreasing trend over the nine years to a value of 2.44% (p &lt; 0.001), due to the elimination of the aerators of taps without filters and also to the introduction of filters in taps of high-risk wards and surgical rooms. We found statistical difference between taps with or without filter (p &lt; 0.001) and a higher positive rate during the summer season compared to the other months. Also, an increase of the positivity rate was detected in some year due to the lack of monthly replacement of the filter.

Conclusions

These results reveal a high level of contamination of taps by opportunistic bacteria with severe implications especially for high-risk settings and therefore, the need to improve the management of these devices.

Key messages

Particular attention must be reserved to the water distribution systems in hospitals in order to prevent the spread of healthcare associated infections. The continued application and strengthening of guidelines and procedures is essential to limit the spread of multidrug resistant pathogens.

Pregnant women and risk factors: a cross-sectional study

Background

Many investigations have shown the important role played by risk factors such as tobacco and alcohol in the development of congenital anomalies.

Methods

Through the administration of an hoc questionnaire, we evaluated the attitude towards smoking and alcohol of a sample of 200 pregnant women at the University Hospital of Messina. The questionnaire was structured to collect information about socio-demographic characteristics, type of gynaecological assistance and their lifestyles (smoking and alcohol). Statistical analysis was performed using version 10 of StatSoftVR software.

Results

14% of the women continued to smoke despite pregnancy; the majority of these were young adults, divorced, employed and with a high educational level. Correlating the smoking habit with the socio-demographic characteristics of the studied women, we found a statistically significant difference for the marital status, with a higher number of smokers among the single women (p &lt; 0.05).Moreover, we found a statistically significant difference also for the profession with a higher number of smokers in the worker women (p &lt; 0.05). About the drinking habit, the 4.3% declared to be moderate drinkers (occasional use of alcohol equal to 2-3 glasses a week) despite pregnancy, the 34.4% stated they do not drink alcohol during pregnancy and the 56% stated do not usually drink alcohol. Particularly, about the drinkers' socio-demographic characteristics, the 50% of them were 24-25 years old and the 75% were married. About the type of alcoholic beverages consumed, 86% stated they usually drink bier during the weekend.

Conclusions

Our study shows that the awareness of the women about the importance of these risk factors is still rather poor. In order to improve the awareness of pregnant women on the importance of avoiding these risk factors and prevent CAs, health education campaigns at various levels surely represent the public health cornerstone.

Key messages

In our sample 14% of the pregnant women continued to smoke and 4.3% to drink despite pregnancy and they generally were young or young adults and with a high educational level. Our results highlight the importance of continuous health education about the risk to smoke and drink during pregnancy.

Risk perception, knowledge, prevention, information sources and efficacy beliefs related to Covid-19

Background

Sars-Cov-2 is one of the latest examples of an emerging infectious disease challenging the world and it is the third case, in just two decades, of “spillover”. In light of the recent outbreak (Italy is in 2nd position), it is important to evaluate people risk perception and to support the Health Authority with effective communicative actions to avoid the spread of “infodemia”/alarmism. The aim of this study is a) to study levels of perceived threat, risk perception, severity and comparative vulnerability b) to compare risk perception with other communicable/not communicable diseases; c) provide information to increase awareness/ knowledge of the disease.

Methods

We performed an Italian multicentre study from 11 February 2020 and it is still in progress. The subjects in study (general population, HCWs and university students) were enrolled through the administration of a standardized questionnaire based on Health Belief Model through CAPI and CAWI methods. The summary and inferential statistical analyses will be carried out using the R software.

Results

We enrolled 2495 people from 11 February until 4 March 2020. All the respondents had heard of COVID19. Only 2% didn't know any symptoms and 3% answered to all the questions correctly (mean knowledge score of 13). 48% thought that he/she could acquired COVID 19 in the next 12 months and 70% stated that their concern of the disease was high(score5). Perceived capability to avoid it was rated as good/very good by 62%. The correct mask use (WHO) was reported by 64% of the sample and 47% stated all preventive actions (2% no one). Only 22% of the sample stated all actions to be taken in case of suspected acquisition of COVID19.

Conclusions

Italy is facing an epidemic that could have the potential to affect the entire national health system. It's so important to implement public health activities and surveillance systems in order to limit the spread of the disease and bad/disinformation.

Key messages

This study is the first to report on public perception of Sars-Cov-2 in all the Italy. The results indicated that the Italian population is aware of the outbreak and it is concerned about their risk. On the other hand, only half of the sample is aware about all preventive actions and not everybody knows all procedures to be taken in case of COVID 19 suspect.

Streptococcus agalactiae in pregnant women: serotype and antimicrobial susceptibility patterns over five years in Eastern Sicily (Italy)

Streptococcus agalactiae (also known Group B Streptococcus or GBS) represents the main pathogen responsible for early- and late-onset infections in newborns. The present study aimed to determine the antimicrobial susceptibility pattern and the capsular serotypes of GBS isolated in Eastern Sicily over 5 years, from January 2015 to December 2019. A total of 3494 GBS were isolated from vaginal swabs of pregnant women (37–39 weeks), as recommended by the Centers for Disease Control and Prevention. Capsular polysaccharide’s typing of GBS was determined by a commercial latex agglutination test containing reagents to serotypes I–IX. The antimicrobial resistance pattern of GBS was determined through the disk diffusion method (Kirby-Bauer) and the double-disk diffusion test on Mueller-Hinton agar plates supplemented with 5% defibrinated sheep blood, according to the guidelines of the Clinical and Laboratory Standards Institute. Serotypes III (1218, 34.9%) and V (1069, 30.6%) were the prevalent colonizers, followed by not typable (570, 16.3%) and serotypes Ia (548, 15.7%), Ib (47, 1.3%), II (40, 1.1%), and IV (2, 0.1%). All 3494 clinical isolates were susceptible to cefditoren and vancomycin. Resistance to penicillin, ampicillin, levofloxacin, clindamycin, and erythromycin was observed in 6 (0.2%), 5 (0.1%), 161 (4.6%), 1090 (31.2%), and 1402 (40.1%) of the strains, respectively. Most of erythromycin-resistant GBS (1090/1402) showed the cMLS_B phenotype, 276 the M phenotype, and 36 the iMLS_B phenotype. Our findings revealed a higher prevalence of serotype III and a relevant resistance rate, among GBS strains, to the most frequently used antibiotics in antenatal screening.

Comparison of Cell Culture with Three Conventional Polymerase Chain Reactions for Detecting Chlamydophila pneumoniae in Adult's Pharyngotonsillitis

Chlamydophila pneumoniae is an intracellular pathogen responsible for respiratory tract infections. The isolation of the microorganism from clinical specimens is essential for a diagnosis. However, the identification of C. pneumoniae by cell cultures is very difficult besides strongly depending on the sample conditions. The study aimed to investigate, in adult patients with pharyngotonsillitis, the frequency of Chlamydophila pneumoniae detection by cell cultures and three conventional PCRs (a conventional PCR targeting the 16S rRNA gene and two nested PCRs, targeting the 16S rRNA gene and the ompA gene, respectively). The presence of chlamydial inclusion in cell cultures was observed in 11/94 samples (11.70%) by IFA. C. pneumoniae DNA was detected in 12/94 (12.76%) specimens by the 16S rRNA gene nested PCR, 4/94 (4.26%) by ompA gene nested PCR, and in 2/94 (2.13%) by 16S rRNA single-step PCR. Our data show poor agreement between the three applied DNA-amplification methods; in fact, only 16S rRNA gene nested PCR showed a statistically significant difference. Moreover, this result allowed us to achieve a definitive confirmation of the previous finding and to avoid the risk of an overestimation of the C. pneumoniae as a pathogen in pharyngotonsillitis.

Antimicrobial Resistance Profiling of Coagulase-Negative Staphylococci in a Referral Center in South Italy: A Surveillance Study

Background:

CoNS are part of the normal flora of the skin, upper respiratory tract and human intestine. CoNS are able to colonize host tissues or inert materials such as prosthetics, heart valves, pacemakers, and urinary and venous catheters. They can also internalize in host cells, thus eluding immune defenses and attack by antibiotics.

Objective:

In this study, we collected the epidemiological data and determined the antibiotic susceptibility of 828 CoNS, collected in Garibaldi Hospital (Catania, Italy) between January 2016 and October 2018.

Methods:

Strains were evaluated by determining the Minimum Inhibitory Concentration (MIC) using the broth microdilution method, according to the guidelines of the Clinical and Laboratory Standards Institute. The antibiotic sensitivity pattern of CoNS against eighteen antibiotics was determined.

Results:

For all the 828 clinical isolates, varying resistance rates were observed: ampicillin (87%), penicillin (86%), amoxicillin-clavulanate (71%), oxacillin (70%), erythromycin (69%), azithromycin (68%), levofloxacin (55%), ciprofloxacin (54%), gentamycin (47%), moxifloxacin (42%), trimethoprim-sulfamethoxazole (30%), clindamycin (28%), tetracycline (24%), rifampicin (20%), quinupristin-dalfopristin (synercid) (4%). No strains investigated demonstrated resistance to teicoplanin, vancomycin and linezolid.

Conclusion:

Our results highlight the importance of monitoring the evolution of CoNS resistance in order to implement control measures and reduce the risk of spread in the population.

Nine years of microbiological air monitoring in the operating theatres of a university hospital in Southern Italy

INTRODUCTION

Surgical site infections are among the most frequent Health Care Associated Infections with severe impact on mortality and high economic costs; the role of air microbiological contamination in surgical site infections was amply discussed in the scientific literature, highlighting differences in air contamination rates between different ventilation systems, number of people present and door opening rates.

MATERIAL AND METHODS

The aim of our study was to monitor the presence of bacterial air contamination in operating theaters and its relationship with number of people and type of airflow over a period of nine years (January 2010-November 2018) at Messina's University Hospital. The Rho of Spearman test was used to evaluate differences in microbial contamination between empty and working theaters. The impact of the number of people on colony-forming unit values was assessed by performing a stepwise multiple regression analysis. The differences between the results recorded over the nine-year study period were evaluated using the variance analysis. Software R was used for the statistical assessment.

RESULTS

Air samples were taken in each operating theater over nine years. A total of 1,425 samples were collected with a positivity rate of 37.3%. The median bacterial contamination rate was 30 cfu/m3 in empty theaters, while this rate was significantly higher (P < 0.001) in working theaters, where it reached 85 cfu/m3. A statistically significant difference was identified between laminar and turbulent airflow systems, with higher bacterial contamination rates with the latter (p<0.001); in these cases, the value of bacterial contamination (microbial count) was higher in the presence of a higher number of individuals in the operating theater (p<0.001).

CONCLUSION

Our study demonstrates the complexity of the Operating Theatres environment, in which a good ventilation system is, indeed, only one prerequisite for clean air, but other factors, such as the behavior of healthcare professionals and environmental conditions, can influenced the bacterial count.

Perception of rubella risk in pregnancy: an epidemiological survey on a sample of pregnant women

BACKGROUND

Rubella is a common exanthematous viral disease all over the world. The disease can be prevented by administering a safe and effective vaccine, and in Italy it is subject to reporting obligations. A national plan for the elimination of measles and congenital rubella (in Italian "PNEMoRC") was approved in 2003 and updated in 2010. This plan originally aimed at reducing the susceptible target population (women in fertile age, 15-49 years old) to below 5% and at eliminating the congenital form of rubella by 2015, a goal which has not been achieved yet.

STUDY DESIGN

Our research work was focused on a convenience sample of pregnant women attending the antenatal classes at the two main hospitals in Messina, Sicily (Italy).

METHODS

After we obtained an informed consent, we administered to 200 Italian and foreign pregnant women an anonymous questionnaire reporting socio-demographic characteristics, type of gynaecological assistance and information received about Rubella serological statu.

RESULTS

The mean age was 30.6 years ± 5.45. The majority of these women were married, at work and with a high educational level. Most of them (75.3%) reported to be assisted by a private gynaecologist, while only 24.7% used a public facility. A remarkable percentage (62.8%) of these women reported to be serologically negative at the anti-rubella antibodies test, but, only 7.5% of them reported to have passed the anti-rubella antibody test before the conception.

CONCLUSION

Our results clearly show that we are still far from achieving the elimination of rubella risk in pregnancy. We are facing a cultural gap perhaps also due to a generalized loss of "historical memory" about the impact that infectious diseases have had in the past in terms of mortality and morbidity. In fact, alongside the considerable drop in vaccination coverage in the recent years, our research also reveals a reduced focus on pre-conceptional testing and limited awareness of associated risks. Furthermore, we correlated the serological status with the sociodemographic characteristics of these women and found a statistically significant correlation with their age and their educational level (P<0.05). A lot still needs to be done to improve the situation; in particular, better education at various levels could considerably increase the awareness among women about this relevant public health issue.

Evaluation of Vaccination Coverages in the Health Care Workers of a University Hospital in Southern Italy

INTRODUCTION

An adequate immunization of the health care workers is essential for infection prevention and control, to avoid consequences not only for them, but for all patients that the health care workers could infect causing serious damage and / or death. Unfortunately, to date, despite the presence of international and national guidelines (Law Decree 119/2017), the vaccination coverage was low, also because of the "vaccine hesitancy" spread among the same health care workers. In light of the above, the aim of our study was to investigate the vaccination coverage of healthcare workers of all the operational units present in our hospital and to evaluate differences between sex, age, professional profile and area of work.

MATERIALS AND METHODS

A study was conducted from March to June 2018 to investigate the vaccination coverage of healthcare workers at the University hospital "G. Martino" of Messina; data were collected using a self-completion questionnaire based on Attachment 3 of Ministerial Circular 25233 of 18 August 2017. We verified any possible association between physicians and pediatricians and between age classes by the chi square method. Also, a logistic regression was used for each vaccination, considering the vaccination as the variable and the following covariates: type of operative unit, sex, age and area) in order to predict the probability of vaccination.

RESULTS

We analyzed a sample of 822 health care workers (324 males and 498 females with an age of 49.5 ± 10.5 SD). The sample was made up of physicians (36%), nurses (21%) and other professional categories (43%). Analyzing the data we obtained vaccination coverages lower than the target required to guarantee "herd immunity"; higher vaccination coverages were found for females, physicians and the clinical area and - for influenza vaccination - in the older age groups and - for all the other vaccinations - in the younger groups.

CONCLUSION

Data analysis revealed a lax attitude towards vaccinations by health care workers and the need for measures aimed at increasing vaccination their coverage to prevent them from becoming a source of dangerous outbreaks.

Preliminary in Vitro Studies on Corynebacterium urealyticum Pathogenetic Mechanisms, a Possible Candidate for Chronic Idiopathic Prostatitis?

Corynebacterium urealyticum is a well-known opportunistic uropathogen that can occur with cystitis, pyelonephritis, and urinary sepsis. Although a wide variety of coryneform bacteria have been found from the male genital tract of prostatitis patients, only one clinical case of prostatitis caused by C. urealyticum has been reported. The aim of this study was to evaluate the in vitro tropism of C. urealyticum towards LNCaP (lymph node carcinoma of the prostate) human cells line and the influence of acetohydroxamic acid as an irreversible urease inhibitor on different aspects of its pathogenicity by means of several in vitro tests, such as the determination and analysis of growth curves, MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, the production of biofilms, and adhesion to LNCaP and HeLa cell lines. Results have brought new pieces of evidence on the in vitro tropism of C. urealyticum for the human prostate cell line LNCaP and the therapeutic use of the irreversible urease inhibitors such as acetohydroxamic acid (AHA), not only as enzyme blockers to facilitate the removal of encrustations but also as modulators of some pathogenic mechanisms. These interesting preliminary data allow us to assert that there is a real possibility that C. urealyticum is a new candidate for chronic idiopathic prostatitis.

An observational study of university students of healthcare area: knowledge, attitudes and behaviour towards vaccinations

INTRODUCTION

Despite vaccines are the most successful public health interventions for prevention of infectious diseases "vaccine hesitancy" spreads today across the world. Despite attitudes of future generations of HCWs is fundamental, these aren't much analysed in the literature. The aim of our research was a) to evaluate attitudes and behaviours reported towards vaccinations among a sample of university students in the health area, b) to know their vaccination status and intention to get vaccines and c) investigate their propensity to vaccinate (who and with which vaccines).

MATERIALS AND METHODS

We evaluated a sample of university students of the health area of University of Messina through an anonymous face to face questionnaires based on HProimmune survey appropriately modified, analysing presence of statistical difference between gender. All analyses were carried out using EPI INFO software.

RESULTS

Our study showed a general lack of confidence and insecurity towards vaccination by future HCWs and absent perception of the risk of acquire a vaccine preventable disease as they also demonstrate low vaccination coverage in our sample. Their opinion about awareness of recommended vaccines for HCWs also was low, however, they thought that vaccinations should be a prerequisite for healthcare professionals to work in healthcare area. Also, we observed that 96% of respondents would recommend vaccinations to their patients, with a greater propensity of women.

CONCLUSIONS

The motivations of vaccine hesitancy are many and maybe other studies would help policymakers and stake-holders to shape programs to improve vaccination coverage among students and HCWs.

The evolution of vaccines for early childhood: the MMRV

Measles, mumps, rubella and varicella vaccines have greatly reduced the incidence of these four childhood diseases, which in the past caused a considerable burden of morbidity and lethality to the population. Vaccines against MMR, varicella and a tetravalent MMRV vaccine are currently available on the market to provide immunization against measles-mumps-rubella and varicella. A recently passed Italian Law (L 119/2017) on vaccinations increased the number of free of charge but compulsory vaccinations from four to ten, including MMR and varicella, as a requirement for admission to nursery schools and kindergartens; fines may be levied for non compliance, in the attempt to increase vaccination coverage. The Italian National Immunization Program 2017-19 allows immunization to be administered either by: the trivalent anti-measles-mumps-rubella plus the monovalent anti-varicella vaccine, administered in different anatomic sites at the same session, or by a quadrivalent MMRV combined vaccine.

Knowledge, experiences, and attitudes toward Mantoux test among medical and health professional students in Italy: a cross-sectional study

BACKGROUND

The World Health Organization's Action Framework for tuberculosis elimination in low-tuberculosis incidence countries includes the screening for active and latent tuberculosis in selected high-risk groups, including health care workers. In this context, medical and health profession students, exposed to nosocomial tuberculosis transmission during training and clinical rotations, are target populations for tuberculosis screening. No updated data are available on tuberculosis screening practice and knowledge of medical and health profession students in Italy.

METHODS

Within the activities Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health, we carried out a multicentre cross-sectional study to assess knowledge, attitude and practices on tuberculosis prevention and control among Medical, Dentistry, Nursing and other health professions' students. Students were enrolled in the study on a voluntary basis and were administered a previously piloted structured questionnaire. Logistic regression models were applied to explore knowledge on tuberculosis prevention by selected socio-demographic variables and University-based tuberculosis prevention practice.

RESULTS

Students of seventeen Universities across Italy participated in the study, and 58.2% of them received compulsory tuberculin skin test either at enrollment or while attending clinical practice. A total of 5,209 students filled the questionnaire. 37.7% were medicine and dentistry students (Group 1), 44.9% were nursing students (Group 2) and 17.4% were other health professions' students (Group 3). Age and gender had different distributions by groups, as well as knowledge and practice on tuberculin skin test. 84.4% of the study population (95% CI = 83.3-85.3) was aware of the existence of the tuberculin skin test, 74.4% (95% CI = 73.2-75.6) knew what is the first-level screening test for latent tuberculosis and only 22.5% (95% CI = 21.4-23.6) knew how to proceed after a positive tuberculin skin test result. Overall, knowledge on tuberculosis prevention was higher in Group 2 and lower Group 3, as compared to Group 1.

CONCLUSION

In Italy, the knowledge on tuberculosis screening among University students is generally good. To reduce some of the criticalities found among the different study courses, it would be appropriate to harmonize both the regulations on tuberculosis screening practices for admission to University courses, and the educational activities on the topic of tuberculosis, to be extended to all workers involved in health care setting.

Effects of aerators, filters and chlorination on contamination of water samples: a nine years study in a Southern University Hospital

OBJECTIVES

The aim of our study was to evaluate the microbiological contamination by Pseudomonas aeruginosa in the water system of the University Hospital "G. Martino" in Messina over a period of nine years, in order to a) clarify possible relationship between the presence of aerators and contamination, b) to highlight the presence of a yearly variation and c) to verify the statistical difference between microbiological contamination of taps with and without filters.

MATERIAL AND METHODS

We carried out our study between January 2010 and December 2018 through the collection of water samples that were analysed for total bacteria count and Pseudomonas aeruginosa. The differences between the results recorded over the nine-year study period were evaluated using variance analysis. P values of <0.05 were considered statistically significant. Software R was used for statistical assessment.

RESULTS

We analysed a total of 6168 samples with a positive rate of 9.31% and a decreasing trend over the years to a value of 2.44% (p<0.001), due to the elimination of the aerators of taps without filters and also to the introduction of filters in taps of high-risk wards and surgical rooms. We found statistical difference between taps with or without filter (p<0.001) and a higher positive rate during the summer season compared to the other months.

CONCLUSIONS

These results reveal a high level of contamination of taps by opportunistic bacteria with severe implications especially for high-risk settings and therefore, the need to improve the management of these devices.

Antibacterial and anti-biofilm activities of walnut pellicle extract (Juglans regia L.) against coagulase-negative staphylococci

Juglans regia L. (common walnut) is a deciduous tree belonging to Juglandaceae family. Since ancient time, walnut was widely used in traditional medicine for its antioxidant, antidiabetic, antimicrobial, anti-inflammatory, anti-atherogenic and liver-protective effects. In this work, the antibacterial and anti-biofilm activities of walnuts pellicle extract against coagulase-negative staphylococci were evaluated. Qualitative chemical analysis was performed by the thin layer chromatography. UPLC-Ms/Ms was used to identify the chemical composition of J. regia extract. The total flavonoid and phenolic contents were determined by the Aluminium chloride and Folin-Ciocalteu methods, respectively. The extract showed antibacterial activity with MIC ranging from 3.60 to 461.75 µg/ml and MBC ranging from 461.75 to >461.75 µg/ml. Furthermore, it significantly reduced biofilm biomass and cell viability in a dose-dependent manner. Biological activities of J. regia extract may be due to its high flavonoid and phenolic contents. The obtained results are promising and they deserve further scientific investigations.

Drug-resistant bacteria on hands of healthcare workers and in the patient area: an environmental survey in Southern Italy's hospital

OBJECTIVE

Drug-resistant bacteria on hands of healthcare workers and in the patient area: an environmental survey in Southern Italy's hospital.

METHODS

The study was conducted from June 2017 to May 2018 using contact slides for surfaces and active sampling for air. We used automated biochemical methods to identify microorganisms; antibiograms were performed in compliance with the EUCAST expert rules.

RESULTS

We analyzed 3,760 samples, 16.17% were found positive and 34 % of these were antimicrobial-resistant. On analyzing the isolated Staphylococci, 39% were multidrug-resistant and 5% extensively drug-resistant. A 30% of the Enterococcus faecalis isolates were resistant to gentamycin and vancomycin. We found Klebsiella pneumoniae isolates resistant to ceftriaxone, cefoxitin, mecillinam and imipenem. A 7% and 8% of the Acinetobacter baumannii and Pseudomonas aeruginosa isolates, respectively, were resistant to gentamicin, imipenem, and ceftazidime.

CONCLUSIONS

These findings are in line with the international literature, confirming that antimicrobial resistance is also steadily growing in Italy with rates varied for the different pathogens.

Antimicrobial efficacy of cordless sonic or ultrasonic devices on Enterococcus faecalis-infected root canals

AIM

The aim of the present study was to evaluate the immediate and residual antimicrobial activity of cordless sonic or ultrasonic devices on Enterococcus faecalis (E faecalis)-infected teeth.

METHODS

A total of 140 single-rooted extracted teeth with E faecalis were grouped as follows (N = 15): conventional syringe irrigation with 3% sodium hypochlorite activated by ultrasonic device (group 1) or cordless ultrasonic device (group 2), EndoActivator (group 3) or without activation (group 4), conventional syringe irrigation with sterile bi-distilled water and ultrasonic device (group 5), EndoUltra (group 6), EndoActivator (group 7), or without activation (group 8). The remaining 20 teeth were used for positive and negative controls. Colony-forming units (CFU) and turbidity were recorded from bacteriological samples taken before and after irrigation and after 24 hours of re-incubation. Data were statistically analyzed using Student's t test, Mann-Whitney test, Kruskal-Wallis test, and Dunn's multiple comparison tests (P < .05).

RESULTS

Groups 1 and 2 showed higher antimicrobial efficacy than groups 3 and 4 (P < .05). No bacteria reduction was found in groups 5-8 (P > .05). After 24 hours, regrowth of bacteria was not significantly different for all groups (P > .05).

CONCLUSIONS

Ultrasound produced lower CFU and turbidity after treatment and after re-incubation of 24 hours than sonic or no activation.

Combined systemic (fluconazole) and topical (metronidazole + clotrimazole) therapy for a new approach to the treatment and prophylaxis of recurrent candidiasis

Recurrent vulvovaginal candidiasis (RVVC) is an important pathological and infectious condition that can greatly impact a woman's health and quality of life. Clinical and epidemiological studies show that different types of therapies are able to eliminate the signs and symptoms of mycotic vaginitis in the acute phase, but so far none of these has proved able to significantly reduce the risk of long-term recurrence. In this review, based on the available literature and original data from a preliminary in-vitro microbiological study on the compatibility between fluconazole, clotrimazole and metronidazole a new therapeutic approach to RVVC is discussed and presented. The treatment proposed is a combined scheme using both systemic antimicrobial drug therapy with oral fluconazole 200 mg and topical drug therapy using the association metronidazole 500 mg and clotrimazole 100 mg (vaginal ovules) with adjuvant oral probiotic therapy. In detail, at the time of diagnosis in the acute symptom phase, we propose the following treatment scheme: fluconazole 200 mg on day 1, 4, 11, 26, then 1 dose/month for 3 months at the end of the menstrual cycle; plus metronidazole/clotrimazole ovules 1/day for 6 days the first week, then 1 ovule/day for 3 days the week before the menstrual cycle for 3 months; plus probiotic 1 dose/day for 10 days for 3 months starting from the second month to the end of the menstrual cycle. This scheme aims to address the recurrent infection aggressively from the outset by attempting not only to treat acute symptoms, but also to prevent a new event by countering many of the potential risk factors of recurrence, such as the intestinal Candida reservoir, the mycotic biorhythm, the formation of biofilm, the phenotype switching and the presence of infections complicated by the presence of C. non albicans or G. Vaginalis, without interfering, but rather favoring the restoration of the vaginal lactobacillus species. Future clinical studies will be useful to confirm the proposed scheme.

In vitro evaluation of biological activities of Orobanche crenata Forssk. leaves extract

Orobanche crenata Forssk. (Orobanchaceae) is a holoparasitic plant noxious to legumes. Orobanchaceae are well known in traditional medicine for their hypotensive, antihyperglycemic, antispasmodic, analgesic and antimicrobial effects. In this work, the biological activities of the acetonic leaves extract were evaluated. Qualitative chemical analysis was determined through thin layer chromatography. Total phenols and flavonoids content was obtained by the Folin-Ciocalteu and the Aluminium chloride colorimetric methods, respectively. The antimicrobial activity was performed by the broth microdilution method. The extract showed antibacterial activity, particularly against Gram-positive strains, with MIC ranging from 376.00 to 3011.00 µg/ml. Besides, it exhibited antifungal effects on Candida spp. with MIC ranging from 94.10 to 3011.00 µg/ml. In addition, O. crenata inhibited superoxide anion formation and showed a DPPH quenching capacity, particularly at 80 µg/ml. Interestingly, our results are promising thus indicating the importance of O. crenata as a significant source of biologically active natural compounds.

Bioinspired benzoxanthene lignans as a new class of antimycotic agents: synthesis and Candida spp. growth inhibition

In this work we synthetized the bioinspired benzoxanthene lignans (BXLs) 3, 14-22, and the phenazine derivative 23 as potential antimycotic agents. MICs and MFCs against Candida strains were determined. In a preliminary screening, compounds 3, 15, 20, 21, 22 were substantially inactive. Compounds 14 and 17 showed antifungal activity, being able to inhibit the growth of the majority of Candida strains with MIC values in the range 4.6-19.2 µM (14) and 26.0-104.3 µM (17); for three strains, the MICs were lower than those obtained using the antimycotic drug fluconazole. The three BXLs 18, 19 and 23 showed some MIC values lower than that of fluconazole; 18 was also active against two non-albicans Candida strains resistant to fluconazole. Phenazine 23, although active only against one strain (MIC = 1.3 µM), was one order of magnitude more potent than fluconazole. All the BXLs were fungicidal.

"Clean care is safer care": correct handwashing in the prevention of healthcare associated infections

BACKGROUND

In 2005, WHO developed the campaign "Clean care is safer care", aiming at the reduction of Healthcare Associated Infections (HCAI) through the worldwide promotion of appropriate hand hygiene practices. Adherence to these practices presently ranges from 5 to 81% (average 40%).

METHODS

Aim of the study was the evaluation of healthcare workers (HCWs) adherence to the application of WHO guidelines on the hand hygiene and the possible impact on HCAI reduction. First, some wards at highest HCAI risk were identified. Then, direct observational survey was conducted to evaluate the behaviour of the different HCW categories.

RESULTS

Six-hundred-twenty-eight HCWs were observed: 519 nurses (68 in training), 109 physicians (63 in training). Survey analysis highlighted that compliance with handwashing was higher in post care practices (59.6%) than before (55.1%). Some HCWs performed handwashing in both cases. Only in 30.6% of cases HCWs observed the handwashing technique suggested by the guidelines. In 70.4% they wore gloves during procedures in which it was possible to have contact with potentially infectious material, but they did not change them before caring for a new patient in 64% of cases.

CONCLUSIONS

The survey confirms the international data, showing a low compliance with hand hygiene practices by the HCWs and the need to promote a correct handwashing based on respect of the international guidelines.

An evaluation of attitude toward vaccines among healthcare workers of a University Hospital in Southern Italy

BACKGROUND

Vaccination is an effective and safe health technology. Despite this vaccine coverage falls short of national and international targets. Study design. The aim of the study was to evaluate the views of medical staff at Messina University Hospital regarding vaccinations, their current and future vaccination status and whether they recommend it to their patients.

METHODS

The study was conducted from April 2016 to March 2017 by an anonymous face-to-face questionnaire submitted to HCWs.

RESULTS

A general lack of confidence and insecurity about vaccination was shown by a substantial proportion of physicians analyzed while pediatricians showed a positive attitude to vaccines. However, many physicians had not been immunized with the recommended vaccines for HCWs and therefore represent a potential source of infection for both patients and the general population.

CONCLUSIONS

Despite the evidence of the effectiveness and safety of vaccines, compliance by HCWs remains very low for a variety of reasons. A range of measures are therefore needed to ensure their use, not only by the general population, but also by doctors who should be their major promoters.

Effects of a new combination of plant extracts plus d-mannose for the management of uncomplicated recurrent urinary tract infections

Urinary tract infections (UTIs) are an economic burden for public health. The increasing prevalence of resistant bacteria which cause UTIs may be related to the inappropriate prescription of antibiotics. The aim of this preliminary study was to evaluate whether three different combinations of plant extracts plus d-mannose are effective in preventing the recurrence of UTIs. Three groups of patients received three combinations of plant extracts in conjunction with d-mannose. These were: berberine, arbutin and birch (group A); berberine, arbutin, birch and forskolin (group B); and proanthocyanidins (group C). The clinical recurrence of cystitis at the end of treatment and during follow-up was determined by comparison with baseline measurements using the microbiological assessment of urine samples, vaginal swabs and vaginal smear slides. Patients in groups A and B had a lower incidence of episodes of recurrent cystitis during treatment and follow-up, samples with a significantly lower median bacterial load and a reduction of the grade of lactobacillary flora compared to patients in group C.

Blood-Brain Barrier in a Haemophilus influenzae Type a In Vitro Infection: Role of Adenosine Receptors A2A and A2B

The blood-brain barrier (BBB) is mainly made up of tightly connected microvascular endothelial cells (BMECs), surrounded by pericytes (BMPCs) which regulate BBB tightness by providing soluble factors that control endothelial proliferation. Haemophilus influenzae type a (Hia) is able to reach the BBB, crossing it, thus causing meningitis. In this study, by using an in vitro model of BBB, performed with human BMECs and human BMPCs in co-culture, we demonstrated that, after Hia infection, the number of hBMPCs decreased whereas the number of hBMECs increased in comparison with non-infected cells. SEM and TEM images showed that Hia was able to enter hBMECs and reduce TEER and VE-cadherin expression. When the cells were infected in presence of SCH58261 and PSB603 but not DPCPX, an increase in TEER values was observed thus demonstrating that A_2A and A_2B adenosine receptors play a key role in BBB dysfunction. These results were confirmed by the use of adenosine receptor agonists CGS21680, CCPA, and NECA. In infected co-cultures cAMP and VEGF increased and TEER reduction was counter-balanced by VEGF-R1 or VEGF-R2 antibodies. Moreover, the phosphorylated CREB and Rho-A significantly increased in infected hBMECs and hBMPCs and the presence of SCH58261 and PSB603 significantly abrogated the phosphorylation. In conclusion, this study demonstrated that the infection stimulated A_2A and A_2B adenosine receptors in hBMECs and hBMPCs thus inducing the pericytes to release large amounts of VEGF. The latter could be responsible for both, pericyte detachment and endothelial cell proliferation, thus provoking BBB impairment.

Management of two influenza vaccination campaign in health care workers of a university hospital in the south Italy

BACKGROUND

In Europe, flu remains one of the major public health problems. Healthcare workers (HCWs) are a category at high-risk of contracting the infection and infecting their patients; consequently, for this category, vaccination is highly recommended. Unfortuntely, coverage levels remain insufficient with rates ranging between 4 and 40.

STUDY DESIGN

The purpose of our work was to evaluate the adherence of HCWs to the influenza vaccination and to carry out a combination of educational and motivational interventions in order to increase the rate of adherence to the vaccination in this workers' category.

METHODS

We conducted two different influenza vaccination campaigns, 2014-2015 and 2015-2016. The study was divided in two steps. In the first, preliminary step, an anonymous questionnaire was administered to HCWs containing a set of questions in order to gain information about the number of subjects willing to undergo the vaccination and the reasons that led others toits rejection. In the second step, vaccination campaigns were carried out preparing an appropriate vaccination calendar that was communicated to all interested Units and vaccination points located in various wards.

RESULTS

We found a slightly improved compliance trend, from an average of 2.3% in the previous years to 3.3% in 2014 and 7.4% in 2015.

CONCLUSIONS

Despite the observed increase, the adherence remains very low. We found that the main causes of this result are the fear of adverse effects, the negligence and indolence of the same workers and a lack of risk perception of contracting the disease and transmitting it to patients. Our work stressed the importance of offering correct information and of meeting the needs of HCWs, often unable to leave their ward for the excess workload. This could be, in future years, one of the possible solutions to increase vaccination adherence.

Effects of an extract of Celtis aetnensis (Tornab.) Strobl twigs on human colon cancer cell cultures

Cancers of the digestive tract, in particular colorectal cancer (CRC), are among those most responsive to dietary modification. Research has shown that approximately 75% of all sporadic cases of CRC are directly influenced by diet. Many natural compounds have been investigated for their potential usefulness as cancer chemopreventive agents as they have been thought to suppress carcinogenesis mainly during the initiation phase due to their radical scavenger activity. Since there is an increasing interest in the in vivo protective effects of natural compounds contained in plants against oxidative damage involved in several human diseases such as cancer, the aim of the present research was to test the effects of a Celtis aetnensis (Tornab.) Strobl twig extract on a human colon carcinoma cell line (Caco2). In order to elucidate the mechanisms of action of this extract, LDH release, GSH content, ROS levels, caspase-3 and γ-GCS expression were also evaluated. The results revealed that the Celtis aetnensis extract reduced the cell viability of the Caco2 cells inducing apoptosis at the lowest concentration and necrosis at higher dosages. In addition, this extract caused an increase in the levels of ROS, a decrease in RSH levels and in the expression of HO-1. The expression of γ-GCS was not modified in the Celtis aetnensis-treated Caco-2 cells. These results suggest an interference of this extract on the oxidant/antioxidant cell balance with consequent cell damage. The present study supports the growing body of data suggesting the bioactivities of Celtis aetnensis (Tornab.) Strobl and its potential impact on cancer therapy and on human health.

Alterations of the vaginal microbiota in the third trimester of pregnancy and pPROM

OBJECTIVE

Preterm premature rupture of membranes (pPROM) is a significant issue in obstetric practice. One of the risk factors for pPROM are vaginal infections in the third trimester of pregnancy.

PATIENTS AND METHODS

We performed an observational study on 600 pregnant women, analyzing the lactobacillary grade (LBG) and the presence of any pathogenic bacteria and/or Candida at weeks 28 and 32 of pregnancy and recording any pPROM events at delivery. At week 28, in the case of vaginal infection, the patients were treated for 6 days with a topical association of metronidazole+clotrimazole.

RESULTS

At week 28 of pregnancy 54.2% of women had vaginal infection (32.6% bacterial vaginitis, 33.8% candidiasis and 32.4% mixed infection) and/or abnormal vaginal microbiota (67.4% LBG 2a/2b, 32.6% LBG 3). The total number of pPROM was 8 out of 600 (1.3%). The treatment of vaginal infection at week 28 with the topical association of metronidazole+clotrimazole, led to both the eradication of vaginal infections and the restoration of the vaginal microbiota in 72% of the cases, bringing the level of risk of pPROM similar to that of women without vaginal infection at week 28. In addition, the results showed that women with vaginal infections and/or alteration of vaginal microbiota at week 32 of pregnancy had a higher prevalence of pPROM in comparison to the women without vaginal infection at week 32 (p<0.001).

CONCLUSIONS

This observational study showed the high prevalence of vaginal infections in the third trimester of pregnancy and its association with pPROM. Furthermore, data suggested the possible benefits of the topical treatment with metronidazole+clotrimazole in pregnancy to eradicate infections, restore the normal microbiota and reduce the risk of pPROM.

Iatrogenic nocturnal eneuresis – an overlooked side effect of anti histamines?

Nocturnal enuresis is a common disorder in childhood, but its pathophysiological mechanisms have not been fully elucidated. Iatrogenic nocturnal enuresis has been described following treatment with several psychotropic medications. Herein, we describe a 6-year-old child who experienced nocturnal enuresis during treatment with the antihistamine cetirizine. Drug rechallenge was positive. Several neurotransmitters are implicated in the pathogenesis of nocturnal enuresis, including noradrenaline, serotonin and dopamine. Antihistamine treatment may provoke functional imbalance of these pathways resulting in incontinence.

Electrocatalytic conversion of CO2 to produce solar fuels in electrolyte or electrolyte-less configurations of PEC cells

The electrocatalytic reduction of CO2 is studied on a series of electrodes (based on Cu, Co, Fe and Pt metal nanoparticles deposited on carbon nanotubes or carbon black and then placed at the interface between a Nafion membrane and a gas-diffusion-layer electrode) on two types of cells: one operating in the presence of a liquid bulk electrolyte and the other in the absence of the electrolyte (electrolyte-less conditions). The results evidence how the latter conditions allow productivity of about one order of magnitude higher and how to change the type of products formed. Under electrolyte-less conditions, the formation of >C2 products such as acetone and isopropanol is observed, but not in liquid-phase cell operations on the same electrodes. The relative order of productivity in CO2 electrocatalytic reduction in the series of electrodes investigated is also different between the two types of cells. The implications of these results in terms of possible differences in the reaction mechanism are commented on, as well as in terms of the design of photoelectrocatalytic (PEC) solar cells.

Effects of Tithonia diversifolia (Hemsl.) A. Gray extract on adipocyte differentiation of human mesenchymal stem cells

Tithonia diversifolia (Hemsl.) A. Gray (Asteraceae) is widely used in traditional medicine. There is increasing interest on the in vivo protective effects of natural compounds contained in plants against oxidative damage caused from reactive oxygen species. In the present study the total phenolic and flavonoid contents of aqueous, methanol and dichloromethane extracts of leaves of Tithonia diversifolia (Hemsl.) A. Gray were determined; furthermore, free radical scavenging capacity of each extract and the ability of these extracts to inhibit in vitro plasma lipid peroxidation were also evaluated. Since oxidative stress may be involved in trasformation of pre-adipocytes into adipocytes, to test the hypothesis that Tithonia extract may also affect adipocyte differentiation, human mesenchymal stem cell cultures were treated with Tithonia diversifolia aqueous extract and cell viability, free radical levels, Oil-Red O staining and western bolt analysis for heme oxygenase and 5'-adenosine monophoshate-activated protein kinase were carried out. Results obtained in the present study provide evidence that Tithonia diversifolia (Hemsl.) A. Gray exhibits interesting health promoting properties, resulting both from its free radical scavenger capacity and also by induction of protective cellular systems involved in cellular stress defenses and in adipogenesis of mesenchymal cells.

Antioxidant activity of extracts of Momordica foetida Schumach. et Thonn

Momordica foetida Schumach. et Thonn. (Cucurbitaceae) is a perennial climbing herb with tendrils, found in swampy areas in Central Uganda. Antidiabetic and antilipogenic activities were reported for some Momordica species, however the mechanism of action is still unknown. Oxidative stress may represent an important pathogenic mechanism in obesity-associated metabolic syndrome. The present study evaluated free radical scavenging capacity of different concentrations of aqueous, methanolic and dichloromethane leaf extracts of Momordica foetida Schumach. et Thonn. and the ability of these extracts to inhibit in vitro plasma lipid peroxidation; in addition, healthy human adipose mesenchymal stem cell cultures were used in order to test the hypothesis that these extracts may affect adipocyte differentiation. Results obtained in this study suggested that aqueous extract might be useful in preventing metabolic syndrome.