Inpatient Dermatology Consultations in Renal Transplant Recipients. / Interconsulta hospitalaria en dermatología en una unidad de transplante renal.

BACKGROUND: Renal transplant recipients (RTR), which are an increasing population, frequently suffer from post-transplant dermatological complications. Despite the well-established role of dermatologists in the outpatient care of these patients, no previous studies were found concerning dermatology consultations for hospitalized RTR. OBJECTIVES: To investigate the epidemiology of dermatological conditions presented by RTR during hospitalization and assess the impact of dermatology consultations performed in the hospital setting. METHODS: Dermatology consultations requested for RTR admitted at a kidney transplantation referral hospital in Brazil over 36 consecutive months were retrospectively included. RESULTS: 176 consultations were included. Infectious dermatoses prevailed (52.3%), followed by inflammatory diseases (14.2%), neoplasms (12.5%) and drug reactions (8.5%). Diagnostic agreement between requesting and consulting teams was 38.1%. Most consultations were motivated by common dermatological conditions, unrelated to admission diagnosis. There were some differences in comparison to previous studies including general inpatients, such as: larger proportion of infectious dermatoses and neoplasms, smaller proportion of inflammatory diseases, higher percentage of patients submitted to skin biopsy, smaller proportion of consultations managed with a single visit and higher probability of a systemic treatment being recommended in this population. CONCLUSION: Hospitalized RTR present distinct dermatological epidemiology and higher level of complexity, when compared to studies including general inpatients. Dermatology interventions during hospitalization may be beneficial in the multidisciplinary care of these patients, either contributing to the investigation of systemic conditions or providing relief for cutaneous comorbidities.

Safety and efficacy of direct-acting antivirals for the treatment of chronic hepatitis C in a real-world population aged 65 years and older.

The availability of direct-acting antiviral agents (DAA) regimens has expanded the pool of patients eligible for treatment. However, data on the virologic response and tolerability of DAAs in elderly patients are lacking. We evaluated the efficacy and safety of DAAs in patients with advanced fibrosis/cirrhosis in real-life practice with the focus on those aged ≥65 years. Between January and December 2015, all consecutive patients with HCV-related advanced fibrosis/cirrhosis treated with DAA at eleven tertiary referral centres in Emilia Romagna (Italy) were enrolled. Regimen choice was based on viral genotype and stage of disease, according to guidelines. The primary end point was sustained virologic response 12 weeks after the end of treatment (SVR12). Overall, 282 of 556 (50.7%) patients evaluated were elderly, most of them with cirrhosis. Antiviral therapy was stopped prematurely in four (1.4%) patients. Two patients, both with cirrhosis, died during treatment due to worsening of liver/renal function. SVR12 was achieved by 94.7% and was comparable to that obtained in patients aged <65 (P=.074). Similar data were also reported in subgroup of patients aged ≥75 years. All patients with advanced fibrosis achieved virologic response. SVR12 was 80.8% in Child-Pugh-Turcotte (CTP)-B cirrhosis and 95.4% in CTP-A (P=.013). According to genotype, the SVR12 was achieved in 172 of 181 (95%) with genotype 1b cirrhosis and in 44 of 48 (91.7%) with genotype 2 cirrhosis. In conclusions, in a real-world setting, DAAs are safe and effective in elderly patients with HCV-related advanced fibrosis/cirrhosis, but SVR12 is lower with worsening CTP class.

Human papillomavirus detected in viral warts of renal transplant recipients.

OBJECTIVES: Few studies have been conducted in South America regarding the detection and genotyping of human papillomavirus (HPV) in viral warts of renal transplant recipients (RTRs). The characterization of the population most susceptible to the development of warts and the knowledge of the main HPV types in this environment prompted this study, which focuses on the detection and typing of HPV in RTRs in Brazil. METHODS: Fifty-eight patients with viral warts from the Hospital São Paulo/Federal University of São Paulo were included in this study. HPV was detected by polymerase chain reaction (PCR) using combinations of the following primers: PGMY 09/11, RK 91, CP 65/70, and CP 66/69. Restriction fragment length polymorphism and automated sequencing techniques were used for HPV typing. RESULTS: HPV was detected by PCR in 89.7% of viral wart samples. The most frequently detected HPV types included 57, 27, 1a, 2a, and 20. Other types of HPV-epidermodysplasia verruciformis were also detected, including 14, 15, 19, 20, 21, 23, 36, and 38. Rare HPV types were also detected in our environment, including RTR X1, RTR X7, and 100. The time after transplant was correlated with an increased number of lesions and beta papillomavirus genus infection. CONCLUSIONS: The HPV types detected in the RTR population were similar to those described in immunocompetent populations. However, the diversity of the HPV types identified and the number of lesions were increased in the RTR population.

Clinical and histological features of leprosy and human immunodeficiency virus co-infection in Brazil.

BACKGROUND: Both leprosy and human immunodeficiency virus (HIV) are infectious diseases, and are an important global health problem. Patients with leprosy who are co-infected with HIV seem to be at higher risk of developing leprosy reactions. AIM: To examine the histological features of leprosy in patients with HIV and leprosy co-infection, particularly to determine whether the typical leprosy histopathology is present in skin biopsies, and to assess the histological features of leprosy reactions in co-infected patients. METHODS: This was a matched cohort study with 11 co-infected patients and 31 HIV-negative patients with leprosy. A structured protocol for skin-biopsy evaluation was followed, focusing on inflammation of the skin and dermal nerves. RESULTS: Of the 11 HIV-positive patients, 7 (63%) had borderline tuberculoid (BT) leprosy and 5 (70%) of these 7 patients had developed a type 1 reaction. The lesions in these patients were immunologically active, with 100% of biopsies having evidence of compact granulomas, 90% evidence of oedema and 30% evidence of necrosis. CONCLUSIONS: In this study, patients co-infected with HIV and M. leprae had the typical histological lesions of leprosy. There was evidence of immune activation in patients who received combination antiretroviral therapy, and these patients had BT leprosy and leprosy-upgrading reactions.

A NGS approach to the encrusting Mediterranean sponge Crella elegans (Porifera, Demospongiae, Poecilosclerida): transcriptome sequencing, characterization and overview of the gene expression along three life cycle stages.

Sponges can be dominant organisms in many marine and freshwater habitats where they play essential ecological roles. They also represent a key group to address important questions in early metazoan evolution. Recent approaches for improving knowledge on sponge biological and ecological functions as well as on animal evolution have focused on the genetic toolkits involved in ecological responses to environmental changes (biotic and abiotic), development and reproduction. These approaches are possible thanks to newly available, massive sequencing technologies-such as the Illumina platform, which facilitate genome and transcriptome sequencing in a cost-effective manner. Here we present the first NGS (next-generation sequencing) approach to understanding the life cycle of an encrusting marine sponge. For this we sequenced libraries of three different life cycle stages of the Mediterranean sponge Crella elegans and generated de novo transcriptome assemblies. Three assemblies were based on sponge tissue of a particular life cycle stage, including non-reproductive tissue, tissue with sperm cysts and tissue with larvae. The fourth assembly pooled the data from all three stages. By aggregating data from all the different life cycle stages we obtained a higher total number of contigs, contigs with blast hit and annotated contigs than from one stage-based assemblies. In that multi-stage assembly we obtained a larger number of the developmental regulatory genes known for metazoans than in any other assembly. We also advance the differential expression of selected genes in the three life cycle stages to explore the potential of RNA-seq for improving knowledge on functional processes along the sponge life cycle.

Clinical and histological features of leprosy and human immunodeficiency virus co-infection in Brazil

BACKGROUND: Both leprosy and human immunodeficiency virus (HIV) are infectious diseases, and are an important global health problem. Patients with leprosy who are co-infected with HIV seem to be at higher risk of developing leprosy reactions. AIM: To examine the histological features of leprosy in patients with HIV and leprosy co-infection, particularly to determine whether the typical leprosy histopathology is present in skin biopsies, and to assess the histological features of leprosy reactions in co-infected patients. METHODS: This was a matched cohort study with 11 co-infected patients and 31 HIV-negative patients with leprosy. A structured protocol for skin-biopsy evaluation was followed, focusing on inflammation of the skin and dermal nerves. RESULTS: Of the 11 HIV-positive patients, 7 (63%) had borderline tuberculoid (BT) leprosy and 5 (70%) of these 7 patients had developed a type 1 reaction. The lesions in these patients were immunologically active, with 100% of biopsies having evidence of compact granulomas, 90% evidence of oedema and 30% evidence of necrosis. CONCLUSIONS: In this study, patients co-infected with HIV and M. leprae had the typical histological lesions of leprosy. There was evidence of immune activation in patients who received combination antiretroviral therapy, and these patients had BT leprosy and leprosy-upgrading reactions.

[Ergonomics, hygiene and rationality: the "electric house" of Monza (1930)]. / Ergonomia, igiene e razionalità: la "casa elettrica" di Monza (1930).

The "Electric House" of Monza is seen as one of the early example of rationalist architecture produced in Italy. Sponsored by the Italian Edison General Company for Electricity and produced by the Group 7, it was built for the "IV International Triennial Exhibition of Decorative and Modern Industry Arts", held in Monza in 1930. It was conceived as an environment in which the designers showed their interest towards new concepts of rationalist hygiene. Special care was taken to select the environments in relation to the surrounding nature and the needs of life of the house inhabitants: new materials more comfortable, hygienic and rational were inserted. In the kitchen, for example, the architect P. Bottoni, created a space in which the housewife's work was marked by lower energy expenditure, thanks to a careful study of the actions and movements according to the principles of taylorism, here applied to domestic work.

[Work and medicine in Manuali Hoepli series]. / Il lavoro e la medicina nei Manuali Hoepli.

The Authors analyse the Italian, technical series called Manuali Hoepli, devoted to promote technical knowledge in the second half of XIXth century. Johann Ulrich (Ulrico) Hoepli (1847-1935) came from Switzerland to Milan in 1870, and translated into Italian some volumes edited by Macmillan in London (from Science Primers series). During his life, he printed 2000 Manuali Hoepli. Some of them were devoted to Occupational Medicine. Five volumes are presented: Magrini's one was devoted to technical devices to prevent industrial accidents; Allevi's Manual was printed when Milan Clinica del Lavoro was preparing; Altarelli and Bortolotto's manuals show us the fascist way of social medicine.

Acute Generalized Exanthematous Pustulosis Induced by Cefepime: A Case Report.

Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous rash characterized by widespread sterile nonfollicular pustules. Cefepime is a fourth generation cephalosporin, used to treat severe infections. A 67-year-old man was admitted with acute gastroenterocolitis. On the seventh day, the patient developed a nosocomial pneumonia and cefepime was initiated. On the fourth day of cephalosporin treatment, he presented with a maculopapular, pruritic eruption affecting the face, neck, abdomen and limbs. One day later he developed disseminated pustular lesions and his temperature was 37°C. Laboratory analysis evidenced leukocytosis and skin biopsy showed subcorneal pustule, edema in the papillary dermis, perivascular inflammatory infiltrate consisting of neutrophils, leukocytoclasia and red cell extravasation in the epidermis. Cefepime was suspended and within 4 days the non-follicular pustules cleared following a desquamation. AGEP is a disease attributed to a variety of causes, but in 90% of the cases it is due to an adverse drug reaction. Antibiotics are implicated in 80% of these cases, mostly penicillins and macrolides. There are few cases associated with cephalosporins. It is very important to consider AGEP in cases of acute pustular rashes and drugs should be investigated as causative agents.

[1894-1906: new ideas and practice against industrial accidents in Italy]. / 1894-1906: nuove idee e prassi antinfortunistiche in Italia.

In October 1894 was held in Milan the III Congrés International des Accidents du Travail et des Assurances Sociales. 747 delegates participated, coming from 16 nations. In this Congress the theme of a special medical assistance in the industrial accidents was approached for the first time in Italy. In March, 1895 also the Milanese trade union office dealt him with the matter, organizing a specific congress. The trade union movement realized the necessity to approach the problem of industrial accidents. 170 delegates participated to the Congress. The 1895 Congress also represented the occasion for the dawning feminist movement to come into contact with the working class. In 1896 the Association for the Medical Assistance in the Industrial Accidents in Milan was founded. The Association started up a clinical institute. At the end of the XIXth century, with prevention and therapeutic interventions the problem of industrial accidents was faced.

Silicate chain formation in the nanostructure of cement-based materials.

Cement-based materials are ubiquitous in almost all built environment. In spite of this, little is known about the formation and the role played by the silicate chains always present in the cement nanostructure. By means of first principles simulations we provide compelling evidence on the pivotal role played by certain ionic species in the formation of the silicate chains inside the cementitious matrix. Moreover, we corroborate the experimental evidence which shows that the length of the most stable chains with m Si atoms follows a magic-number sequence: m = 3n-1 with n = 1,2,... Our results have been applied in the development of new higher performance cement-based materials by adding nanosilica.

[Development of labor and cardiopathy in the 20th century]. / Evoluzione del lavoro e delle cardiopatie nel XX secolo.

BACKGROUND: The 20th century began with symbolic dates (1902-1903) for cardiology and occupational medicine: Willem Einthoven (1860-1927) invented the electrocardiograph; Milan city council decided (November 20, 1902) the foundation of the Clinic of Occupational Diseases (afterwards the Clinica del Lavoro). OBJECTIVES: To explain how the concepts of heart and work have evolved during the 20th century, two aspects have been considered: evolution of techniques and instruments. METHODS: A review of the historical literature was made using history of medicine databases (HISTMED, WELLCOME) and bibliographical sources. RESULTS AND CONCLUSION: The first landmark was physiology in the late 19th century (Angelo Mosso, 1846-1910, and his studies on fatigue and physiology of inhabitants of the Alps). In the 1930's there were fatigue tests; after Second World War came threadmills and from the 1960's CCU's. At present, electronics and informatics dominate the scene. What can we say about occupational cardiology? We can recall figures like Luigi Ferrannini (the first professor of Occupational Medicine in Italy), who studied the cardiovascular system in connection with work, or Domenico Cesa-Bianchi (1879-1956), who studied animal fatigue (with tapis roulant). In the 1940's the problem was: cardiopathic subjects and work (i.e. cardiopathic patients who can work, or who should work). Then, new risk factors were analysed. In conclusion, the message that the historian of medicine should give to cardiologists and occupational physicians, is that efforts must be made to preserve this specific scientific and technical heritage.

Detection and typing of human papillomavirus in cutaneous warts of patients infected with human immunodeficiency virus type 1.

BACKGROUND: Cutaneous warts are caused by human papillomavirus (HPV). To date, more than 120 different types of HPV are known, of which 80 have been completely characterized. Prevalence studies on types of HPV present in cutaneous warts have been carried out in immunocompetent individuals and immunosuppressed organ allograft recipients, but not in human immunodeficiency virus (HIV)-positive patients. OBJECTIVES: To determine the HPV types present in cutaneous warts of HIV-infected patients. METHODS: Twenty-five biopsies of cutaneous warts from HIV-infected patients and 14 samples from control non-HIV-infected patients were studied. HPV detection was performed by polymerase chain reaction using two sets of primers: MY09/MY11 and RK91. The type of HPV was determined by restriction fragment length polymorphism analysis and direct sequencing of the amplified products. RESULTS: HPV DNA was detected in 64% of cutaneous warts from HIV-infected patients and in 79% of samples from the control group. The HPV types identified in HIV-infected patients were: HPV 2 (38%), 57 (31%), 27 (12%), 6 (12%) and 7 (6%). HPV 2/27/57 predominated in both groups, being present in 81% of lesions from HIV-infected patients and 82% of samples from non-HIV-infected patients. HPV 6, a genital HPV type rarely found in cutaneous lesions, was detected in two warts from HIV-infected patients and in one lesion of the immunocompetent group. HPV 7, characteristically associated with butcher's warts, and recently detected in oral and perioral lesions of HIV-infected patients, was found for the first time in a non-facial lesion of an HIV-infected patient. CONCLUSIONS: This is the first study evaluating the prevalence of HPV types in cutaneous warts of HIV-infected patients and immunocompetent individuals in Brazil.

[Project of the historical monograph on the "Origins of Occupational Medicine Associations in the world"]. / Il progetto della monografia storiografica sulle "Origini delle Associazioni di Medicina del Lavoro nel mondo".

The present contribution regards the project of the historical monograph on the Origins of OH associations in 23 countries, and in particular the chapter on the Origins of the Italian Society of Occupational Health. The Italian chapter is aimed at studying the foundation of the Italian Society of Occupational Health (Naples, October 12, 1929, within the 8th National Congress of Occupational Health) and the first decades of its activity. On account of the complexity and variety of the scientific and social context as well as the particular political period considered, the contribution is divided into 4 different parts. The first deals with the foundation of the Italian Society of Occupational Health and its statutory organization. The second part treats the role and presence of the discipline in the university world as well as the relationships with other cultural institutions such as academies. The third part concerns the law frame (specially as to accidents and work-related diseases) within which the activity of the Italian Society of Occupational Health has started and developed. The fourth part analyses the fascist corporative system and the role played by the trade unions in promoting better life and working conditions, with common issues also with the programmes of the Italian Society of Occupational Health. Finally, some closing remarks and references are provided.

[3-year-survival and quality of life after out-of-hospital heart arrest]. / Sopravvivenza a tre anni e qualità di vita dopo arresto cardiocircolatorio extraospedaliero.

Although the long- and short-term aspects of the outcome of advanced cardiopulmonary resuscitation on patients have been studied to evaluate the percentage of survival up to the moment of discharge from hospital, little information has been published concerning the patients' long-term quality of life. In order to verify the efficiency of our group we retrospectively evaluated 468 subjects admitted to the Emergency Room of Rho Hospital (Milan, Italy) for out-of-hospital cardiac arrest that had occurred over a 90-month period. We studied the correlations between some variables: epidemiological (sex and age), objective (time required for advanced cardiopulmonary resuscitation and type of arrhythmias in the Emergency Room) and instrumental (left ventricular ejection fraction) and post-discharge survival. We also considered the state of health of the survivors by means of a questionnaire on their quality of life. Our data show that: a) 10.25% of the patients were discharged alive; b) younger men (< 65 years old) admitted with a ventricular fibrillation (p = 0.01) and those who had undergone advanced cardiopulmonary resuscitation for less than 25 min (p = 0.001) had a better survival rate at 3 years from discharge; c) 64% of the survivors have a satisfactory quality of life; d) younger age (p = 0.01) and cardiac left ventricular ejection fraction (> 40%) (p = 0.05) are positive predictors for future work capacity. In conclusion, we believe that the critical moment following advanced cardiopulmonary resuscitation is hospitalization because after discharge survival percentage abruptly increased from 10.25 to 65%.

[Hemo-lymphopoietic tumors in agriculture. Case-control study in an epidemiologic area of southern Bari]. / Tumori emolinfopoietici ed agricoltura. Studio caso-controllo in un'area epidemiologica del sud-barese.

In order to evaluate the association between hemolymphoietic tumors and agriculture, we are carrying out a case-control study in the southern province of Bari (Italy). In the period 1st July 1987-30 June 1989, seventy-one incident cases of limphomes, leukemias and multiple myeloma and three fold higher number of controls (other tumors) aged more than fourteen years old were selected. A structured questionnaire was carried out to collect informations, focusing attention to the use of pesticides. For the evaluation of the exposure to specific substances a crop exposure matrix with "multiple circumstantial determinants" (crops and/or type of breeding, phytopatologies, areas and time windows) will be used. In this update a specific pesticides analysis was not conducted. Therefore, we classified as exposed farmers, farm laboures, breeders and whoever affirmed the regular use of pesticides. Up to 1st July 1995, one hundred and seventy-three subjects were contacted. Twenty-three (13%) of them refused to participate to the study, one hundred and fifteen (87%) of them, thirty-one (21%) case and one hundred and nineteen (79%) controls, were interviewed. Nineteen (61%) of cases were males, twelve (39%) of cases were exposed; seventy-two (60.5%) of controls were males, fourty-five (38%) of controls were exposed. The risk of hemolymphoietic tumors associated with exposure was null (O.R. = 1.04; I.C. 95% = 0.42-2.50); no job category (farmer, farm labourer, breeder) was statistically significant associate with cases. An association with farmer (O.R. = 4.87; I.C. 95% - 1.12-20.52) and breeder (O.R. = 4.83; I.C. = 1.19-18.11) was statistically significant if those fourteen subjects with leukemia were considered as cases. Using a logistic model (which independent variables were age, sex, information gathered directly from the subject of from relatives and smoking habit) O.R. for leukemia and farmer resulted statistically significant (O.R. = 5.38; I.C. 95% = 1.31-21.99); instead a considerable decreased O.R. was observed for leukemia and breeder (O.R. = 1.20; I.C. 95% = 0.73-2.00). These results could be subject to variation after the next data input.