Epidemiology, characteristics, and outcome of infective endocarditis in Italy: the Italian Study on Endocarditis

Background

The characteristics of patients with infective endocarditis (IE) vary significantly by region of the world. The aim of this study was to evaluate the contemporary epidemiology, characteristics, and outcome of IE in a large, nationwide cohort of Italian patients.

Methods

We conducted a prospective, observational study at 24 medical centers in Italy, including all the consecutive patients with a definite or possible diagnosis of IE (modified Duke criteria) admitted from January 2004 through December 2009. A number of clinical variables were collected through an electronic case report form and analyzed to comprehensively delineate the features of IE. We report the data on patients with definite IE.

Results

A total of 1,082 patients with definite IE were included. Of these, 753 (69.6?%) patients had infection on a native valve, 277 (25.6?%) on a prosthetic valve, and 52 (4.8?%) on an implantable electronic device. Overall, community-acquired (69.2?%) was more common than nosocomial (6.2?%) or non-nosocomial (24.6?%) health care-associated IE. Staphylococcus aureus was the most common pathogen (22.0?%). In-hospital mortality was 15.1?%. From the multivariate analysis, congestive heart failure (CHF), stroke, prosthetic valve infection, S. aureus, and health care-associated acquisition were independently associated with increased in-hospital mortality, while surgery was associated with decreased mortality.

Conclusions

The current mortality of IE remains high, and is mainly due to its complications, such as CHF and stroke.     

Implantation of a completely subcutaneous ICD system: case report of a patient with Brugada syndrome and state of the art

Aims  

Complications of implantable cardioverter-defibrillator (ICD) therapy are often linked to transvenous lead insertion, lead failure, or infections. An entirely subcutaneous ICD system (S-ICD) avoids the need for the placement of electrodes within the heart and can provide clinical advantages.     

Trehalose/sodium hyaluronate eye drops in post-cataract ocular surface disorders

International Ophthalmology - Prospective, randomised, open-label, comparative study to evaluate efficacy of trehalose/sodium hyaluronate eye drops for post-operative discomfort and tear film...     

Hepatitis Status and Mortality in Hemodialysis Population

The role of hepatitis B (HBV) and C (HCV) virus infection in mortality among MHD patients is poorly understood. Recent studies have shown that HCV positivity is associated with significantly higher cardiovascular mortality, especially in dialysis patients younger than 65 years. However, little information is available in European renal registries about mortality among HBV and HCV positive MHD patients. We prospectively followed all patients (prevalents and incidents) attending the dialysis center in the Sicilian region since January 1, 1999, up to December 31, 2000. Those who died for any cause after the starting point were identified and included in the cases population. In all, 698 eligible cases were found. For each case, three controls extracted from the Registry were matched by age at death (within five years) and sex. We calculated the sample size of 698 cases and three controls for each case, assuming the power of the study to be 80%, with an estimated prevalence of exposure among controls of 3.0%. The χ² and the t-test were used to evaluate possible differences among cases and controls for the different variables under investigation. The ORs of the association between hepatitis infection and mortality, adjusted for each of the possible confounding factors, was calculated using the Mantel-Haenszel test. The prevalence of Hepatitis C (HCV) was much higher among case compared with controls, both in males (23.4%?vs. 17.7?%) and females (25.0%?vs. 22.4%). In the multivariate model, the association between HCV and mortality maintained a significant association only among women aged?<65 years with an OR of 1.77 (95%?CI: 1.12–2.79). We also observed a correlation between increased risk of mortality in hemodialysis and HCV-positive patients with a longer time on dialysis. Our results suggest that HCV positivity among MHD patients is associated with significantly higher mortality in female aged?<65 years. For this reason we should be more aggressive in identifying, preventing, and treating HCV infection among patients with end stage renal disease.     

Primary umbilical endometriosis. Case report and discussion on management options

INTRODUCTIONWe report a recently observed case of primary umbilical endometriosis (UE), with the main aim to discuss the management of this rare condition.PRESENTATION OF CASEA 24-year-old woman complained of a painful nodule on her umbilical region, bleeding with her menstrual cycle. Ultrasonography showed a hypoechoic superficial mass in the umbilicus and no signs of intra-abdominal endometriosis. Excision of the nodule under local anesthesia was performed. Histopathological analysis confirmed the diagnosis of umbilical endometriosis. Neither symptoms nor signs of local recurrence have been observed after 24 months.DISCUSSIONUE should be taken into account in differential diagnosis of umbilical disorders even in young nulliparous women with no typical symptoms of pelvic endometriosis. Although there is a substantial agreement about the necessity of surgery, treatment options are either local excision of the lesion or removal of the whole umbilicus with or without laparoscopic exploration of the peritoneal cavity. The decision should be tailored for the individual patient, taking into consideration the size of the lesion, the duration of symptoms and the presence of possible pelvic endometriosis.CONCLUSIONLocal excision saving the umbilicus may be the treatment of choice in patients with small UE lesions.     

Different ploidy levels of megakaryocytes generated from peripheral or cord blood CD34+ cells are correlated with different levels of platelet release

Ploidy could be the key to understanding megakaryocyte (MK) biologyand platelet production. Human CD34⁺ cells purified fromumbilical cord blood (CB) and peripheral blood (PB) were investigatedon their capability to give rise, in a serum-free medium containingthrombopoietin, to MKs and platelets. CB-MKs showed reducedpolyploidization and platelet number compared with PB-MKs, but asimilar membrane phenotype. Most CB-MKs showed a 2N content of DNA(~80%) and only 2.6% had 8N, whereas 40% of the PB cells had 8N ormore. Platelets were substantially released in PB culture from day 12;at day 14 the CB-derived MKs were able to release platelets although ata reduced level (~35%), correlating with their reduced size. Adirect correlation was demonstrated by sorting polyploid cells fromPB-MKs and evaluating the platelets released in the supernatant.Furthermore, the study analyzed the expression and distribution ofcyclin D3 and cyclin B1. Cyclin D3 protein was increased in PB incomparison to CB-MKs; in PB culture most cells rapidly became positive,whereas in CB-derived cells cyclin D3 expression was evident only fromday 9 and in a reduced percentage. Cyclin B1 was essentially localizedat the nuclear level in the CB and was expressed during the wholeculture. In PB-MKs, at day 9, a reduction was observed, correlatingwith an advanced ploidy state. The data indicate the inability of the CB-MKs to progress in the endomitotic process and a direct correlation between DNA content and platelet production.     

Addiction and empathy: a preliminary analysis

Addicted patients show impaired social functioning. Chronic drug consumption may lead to impairments in decoding empathic cues. The aim of the study is to explore empathy abilities in addicted patients and the hypothesis of a differential impairment between affective and cognitive empathy. 62 addicted patients and 40 healthy volunteers were evaluated using the empathy quotient (EQ) and its subscales cognitive empathy (factor 1), emotional empathy (factor 2), social skills (factor 3). Patients scored statistically significantly lower than controls in EQ total score, in particular in factor 2. No difference was found in factor 1 and in factor 3. Consistent with previous findings, our study suggests specific impairment in emotional empathy combined with preserved cognitive empathy. These findings show important clinical implication in the development of specific rehabilitative programmes for the empowerment of empathy abilities and interpersonal skills that constitute important components in the prevention of relapse.     

Central precocious puberty in Klinefelter syndrome: A case report with longitudinal follow-up of growth pattern

We report idiopathic central precocious puberty in a boy with Klinefelter syndrome and describe the pattern of linear growth and body proportion from the onset of precocious puberty to final height. The patient was not treated for precocious puberty. He reached adequate adult height, for both general population and normative values of Klinefelter syndrome and normal body proportions. We conclude that precocious puberty in Klinefelter syndrome may result in normal body proportion by inducing a major growth spurt of the trunk rather than in the limbs, and that adult height prognosis is not altered by precocious puberty. Given the possible occurrence of precocious puberty in Klinefelter syndrome, we advise a karyotype analysis in boys with sexual precocity, mainly in those who show small rather than enlarged testes. © 1996 Wiley-Liss, Inc.