Eight Italian Regions have begun offering vaccination against varicella to children aged 13-15 months, with a second dose at 5-6 years of age. A serosurvey was conducted to evaluate the impact of extensive vaccination in these "pilot" Regions.

Objective: To show the prevention of adhesion formation by placing an absorbable adhesion barrier after intracapsular myomectomy. Design: Prospective blinded observational study. Setting: University-affiliated Hospitals. Patient(s): Patients R18 years old with single or multiple uterine fibroids removed by laparoscopic or abdominal intracapsular myomectomy. Intervention(s): A total of 694 women undergoing laparoscopic or abdominal myomectomy were randomized for placement of oxidized regenerated cellulose absorbable adhesion barrier to the uterine incision or for control subjects without barriers. The presence of adhesions was assessed in 546 patients who underwent subsequent surgery. MainOutcomeMeasure(s): Theprimaryandsecondaryoutcomesoftheanalysiswerethepresenceandseverityof adhesions for four groups: laparotomy with barrier, laparotomy without barrier, laparoscopy with barrier, and laparoscopy without barrier. Result(s): Therewasahigherrateofadhesionsinlaparotomywithoutbarrier(28.1%)comparedwithlaparoscopy with no barrier (22.6%), followed by laparotomy with barrier (22%) and laparoscopy with barrier (15.9%). Additionally, the type of adhesions were different, filmy and organized were predominant with an adhesion barrier, and cohesive adhesions were more common without an adhesion barrier. Conclusion(s): Oxidized regenerated cellulose reduces postsurgical adhesions. Cohesive adhesions reduction was noted in laparoscopy.

Purpose of the study Metabolic syndrome represent a cluster of cardiovascu- lar risk factors that has become a serious problem for HIV-1-infected patients. It was proposed that distur- bances in phosphate metabolism may represent a key feature of metabolic syndrome. Because phosphate is involved directly in carbohydrate metabolism, hypopho- sphatemia can results in impaired utilization of glucose, insulin resistance and hyperinsulinemia. Thus, we undertook the present study to investigate the relation- ship between phosphate levels and the presence of the characteristics of metabolic syndrome, as well as the mechanism that may be responsible for reduced phos- phate levels in patients with this syndrome. Methods 130 HIV-1-infected patients were consecutively enrolled in a prospective, cross-sectional, single centre study. All patients were receiving HAART for more than six months. We selected two groups: HIV+ patients with metabolic syndrome (group A, n=86) and HIV+ patients without metabolic syndrome (group B, n=44). The diag- nosis of metabolic syndrome was based on Adult Treat- ment Panel III guidelines. Demographic characteristics, metabolic variables, duration of Tenofovir therapy, dura- tion of HAART, CD4 and viral load were collected. Kid- ney tubular function was examined using tubular resorption of phosphate and normalized renal threshold phosphate concentration. Summary of results Patients with metabolic syndrome showed significantly lower phosphate (3.13 mg/dl vs 3.55 mg/dl, p<0.01) and higher insulin (13.2 mg/dl vs 6.9 mg/dl, p<0.01) levels compared with controls. There was a linear significant decrease in phosphate values as the number of compo- nents of metabolic syndrome increased (p<0.001). Multi- ple regression analysis including all 5 components of metabolic syndrome and months of TDF treatment showed that insulin level was the most discriminant of serum phosphate (r= -0.22, p<0.01). Figure 1 Conclusions Our preliminary data demonstrated that HIV-1-infected patients with metabolic syndrome showed significantly lower phosphate levels compared with HIV-1-infected patients without metabolic syndrome regardless of teno- fovir based therapy. The clinical significance of these disturbances, as well as their importance as target for preventive or therapeutic interventions, remains to be established.

Background: Metabolic syndrome (MS) represents a cluster of cardiovascular risk factors that has become a serious problem for HIV-1-infected patients. It has been proposed that disturbance of phosphate metabolism may represent a key feature of MS. Thus, we undertook the present study to investigate the relationship between phosphate levels and the presence of the characteristics of MS. Methods: One hundred and twenty-one HIV-1-infected patients were consecutively enrolled in a prospective, cross-sectional, single-centre study. Kidney tubular function was examined using tubular resorption of phosphate and normalized renal threshold phosphate concentration. Results: Univariate analysis showed that serum phosphate levels correlated negatively with systolic and diastolic blood pressure, glucose values, waist circumference, insulin, and triglycerides. Moreover, there was a positive relationship between phosphate and high-density lipoprotein (HDL) cholesterol. Multivariate analysis showed that insulin levels were correlated with serum phosphate concentration (r = − 0.24, p = 0.01). Conclusions: Our data show that HIV-1-infected patients with MS have lower phosphate levels.

The Mediterranean diet (MD) is considered one of the healthiest dietary models, as it decreases the risk of chronic diseases and may modulate the organism's early response to environmental pollution. In recent decades, Mediterranean countries have been replacing their traditional diet with other less healthy eating habits, especially among children and teenagers.

Purpose: The aim of our study was to evaluate whether perirenal fat thickness (PRFT), a parameter of central obesity, is related to kidney function and intrarenal artery resistive index (IARI) in human immunodeficiency virus (HIV)-1-infected patients. Materials and Methods: We enrolled 102 consecutive HIV-1-infected patients receiving highly active antiretroviral therapy for more than 12 months in a prospective cohort study. Echographically, the PRFT and IARI were measured and the serum metabolic parameters were evaluated. PRFT and IARI were measured using a 3.75 MHz convex linear probe. Results: The mean of PRFT and IARI in HIV-1-infected patients with visceral obesity was considerably higher than that in patients without it (P <0.001 and <0.01, respectively). Using the average IARI as the dependent variable, age (odds ratio, 1.07; 95% confidence interval [CI], 1.01–1.14; P < 0.5) and PRFT (odds ratio, 1.28; 95% CI, 1.08–1.51; P<0.01) were independent factors associated with IARI. Conclusion: Our data indicate that ultrasonographic assessment of PRFT may have a potential to be a marker of increased endothelial damage with specific involvement of the renal vascular district in HIV-1-infected patients.

Introduction. This study aimed to estimate the most recent cae- sarean section rates in the world and examine the association between these rates and old and new indicators of health care. Methods. Authors analyzed the CS rates, also in geo-economic and economic groups, and correlated them to maternal and neo- natal mortality, to births attended by skilled health personnel and to births among adolescents. Analysis of covariance and piece- wise regressions were used for the statistical analysis. Results. In 47.2% of the countries, the CS rate exceeded 15%. Countries of Latin America and the Caribbean along with Europe, North America and Oceania had the highest values. The analysis showed an inverse association between CS rates and MMR and NMR for all geographical areas except for Europe. The great- est association was observed in lower-middle-income countries. In developing countries only 50% of cases, occur in medical facilities and only half of these are seen by medical, nursing and obstetrical staff. Age of the mother appears to influence the out- come and choice of delivery type. Countries where an high ABR rate is present have low CS use. Conclusions. To best evaluate the consequences of the increas- ing rate of CS, it would be useful to identify the most sensitive outcome indicators.

BACKGROUND: Human immunodeficiency virus (HIV) infection and antiretroviral treatment are associated with metabolic and cardiovascular complications that potentially increase the risk of atherosclerosis and cardiovascular disease in this population. Measurement of arterial wall thickness has been used as a surrogate of extent, severity and progression of atherosclerosis. A cross-sectional cohort study was performed to compare the validity of two non-invasive arterial measures: carotid intima-media thickness (IMT), a parameter of atherosclerosis, and ophthalmic artery resistance index (OARI), an index of occlusive carotid artery disease. METHODS: A total of 95 patients receiving highly active antiretroviral therapy (HAART) for more than 12 months were consecutively enrolled. IMT and OARI were measured by 7.5 MHz linear probe. RESULTS: There was a significant linear increase in IMT and OARI values as the grade of cardiovascular risk (0.70 and 0.69 for very low risk, 0.86 and 0.72 for low risk and 0.98 and 0.74 for medium/high risk, p < 0.001). A IMT > 0.83 and an OARI > 0.72 were the most discriminatory values for predicting a cardiovascular risk ≥ 10% (sensibility 89.6% and 75.8%; sensitivity 70.5% and 68.4%; p < 0.001). CONCLUSIONS: Our data indicate that OARI may have a potential as a new precocious marker of subclinical atherosclerosis in HIV-1-infected patients.

BACKGROUND: Pruritus can be defined as an unpleasant cutaneous sensation associated with the immediate desire to scratch. In particular external intimate zone could be hit by pruritus genitalis because of several reasons (bacterial infection, fungal infection, stress, bad intimate behavior, synthetic intimate clothes). AIM: The aim of the study was to compare the efficacy of Dermoxen® Lenitiva cream versus a methylprednisolone aceponate 0.1% based cream in treating pruritus of the external genitalia. PATIENTS AND METHODS: Independent, randomized, double-blind, controlled trial in two University affiliated Italian Hospitals. 80 women, affected by aspecific pruritus genitalis with negative vaginal swab for bacterial or fungal infections or other pathogenic causes of itching, were selected and blindly treated by Dermoxen® Lenitiva cream or methylprednisolone aceponate 0.1% based cream. The main outcome measures were: the reduction of sensation of pruritus, evaluated by a visual analog scale (VAS) pain score, and improvement of intimate wellness sensation, and comfort during sexual intercourse, frequency and severity of adverse reactions. RESULTS: Significant reduction of itching sensation was verified for each treatment. CONCLUSIONS: Based on our results, DermoXen® Lenitiva vaginal cream showed efficacy so as methylprednisolone aceponate 0.1% based cream for itching treatment on external female genitalia and improved intimate comfort and comfort in sexual intercourse.

The MAPEC-Life project aims to study the biological effects of early exposure to air pollutants on the oral mucosa cells of school-age children in five Italian cities. A questionnaire was created to evaluate the association between outdoor and indoor airborne pollutants, lifestyle, diet and biomarker effects. The feasibility and reliability of the questionnaire were evaluated.

Artemisia annua tea has been proven to be a very effective treatment for malaria in various clinical trials, but to date its efficacy has not been investigated in vitro. A study was therefore performed to evaluate the effects of A. annua tea on Plasmodium falciparum cultures in vitro. The concentration of artemisinin in the herbal tea preparation was also determined. The herbal tea extract was tested against chloroquine (CQ)-sensitive D10 and CQ-resistant W2 strains of P. falciparum using the parasite lactate dehydrogenase assay. Quantification of artemisinin in the extract of leaves of A. annua was performed using proton nuclear magnetic resonance (1H-NMR). Results of the in vitro tests were consistent with the clinical efficacy of A. annua tea [50% inhibitory concentration (IC50) for strain D10=1.11±0.21μg/ml; IC50 for strain W2=0.88±0.35μg/ml]. The concentration of artemisinin in A. annua tea (0.18±0.02% of dry weight) was far too low to be responsible for the antimalarial activity. The artemisinin present in the tea is probably co-solubilised with other ingredients, some of which also have antimalarial activity and act synergistically with it. These compounds also merit further research to determine whether their presence hinders the development of parasite resistance compared with pure artemisinin.

The aim of the study was to evaluate if and how varicella prevalence has changed in Italy. In particular a seroprevalence study was performed, comparing it to similar surveys conducted in pre-immunization era. During 2013-2014, sera obtained from blood samples taken for diagnostic purposes or routine investigations were collected in collaboration with at least one laboratory/center for each region, following the approval of the Ethics Committee. Data were stratified by sex and age. All samples were processed in a national reference laboratory by an immunoassay with high sensitivity and specificity. Statutory notifications, national hospital discharge database and mortality data related to VZV infection were analyzed as well. A total of 3707 sera were collected and tested. In the studied period both incidence and hospitalization rates decreased and about 5 deaths per year have been registered. The seroprevalence decreased in the first year of life in subjects passively protected by their mother, followed by an increase in the following age classes. The overall antibody prevalence was 84%. The comparison with surveys conducted with the same methodology in 1996-1997 and 2003-2004 showed significant differences in age groups 1-19 y. The study confirms that in Italy VZV infection typically occurs in children. The impact of varicella on Italian population is changing. The comparison between studies performed in different periods shows a significant increase of seropositivity in age class 1 - 4 years, expression of vaccine interventions already adopted in some regions.

Human bocavirus (HBoV) is a parvovirus isolated about a decade ago and found worldwide in both respiratory samples, mainly from early life and children of 6-24 mo of age with acute respiratory infection, and in stool samples, from patients with gastroenteritis. Since then, other viruses related to the first HBoV isolate (HBoV1), namely HBoV2, HBoV3 and HBoV4, have been detected principally in human faeces. HBoVs are small non-enveloped single-stranded DNA viruses of about 5300 nucleotides, consisting of three open reading frames encoding the first two the non-structural protein 1 (NS1) and nuclear phosphoprotein (NP1) and the third the viral capsid proteins 1 and 2 (VP1 and VP2). HBoV pathogenicity remains to be fully clarified mainly due to the lack of animal models for the difficulties in replicating the virus in in vitro cell cultures, and the fact that HBoV infection is frequently accompanied by at least another viral and/or bacterial respiratory and/or gastroenteric pathogen infection. Current diagnostic methods to support HBoV detection include polymerase chain reaction, real-time PCR, enzyme-linked immunosorbent assay and enzyme immunoassay using recombinant VP2 or virus-like particle capsid proteins, although sequence-independent amplification techniques combined with next-generation sequencing platforms promise rapid and simultaneous detection of the pathogens in the future. This review presents the current knowledge on HBoV genotypes with emphasis on taxonomy, phylogenetic relationship and genomic analysis, biology, epidemiology, pathogenesis and diagnostic methods. The emerging discussion on HBoVs as true pathogen or innocent bystander is also emphasized.

We have studied the occurrence of hBoV, hMPV and InfA-B in an Apulian population with respiratory tract infections. During influenza season 2008-2009, 116 oropharingeal swabs were collected from patients affected by Influenza-Like Illness (ILI). The PCR products of hMPV M and HBoV NP-1 genes were sequenced. 78 out of 116 samples were positive for at least one respiratory virus; hBoV was detected in 53, hMPV in 22 and InfA-B in 41 out of 116 swabs. A high rate of hBoV infection in adult (18.9%) and elderly (26.4%) subjects was found. The co-infection rate was higher for hMPV (18/22 cases, 81.8%) compared to hBoV (26/53 cases, 49.1%), and InfA-B (25/41 cases, 61.0%). Co-infections were common in children. hBoV positive samples shared a high level of genetic similarity with the hBoV1 genotype, and hMPV positive samples clustered with A2 subgroup. Our results suggest that hBoV and hMPV play a role in ILI.

SUMMARY. Hepatitis E virus (HEV) is considered an emerging pathogen in industrialized countries. The occurrence of HEV genotypes in samples of faeces from asymptomatic migrants arriving on the coasts of South Italy and environmental samples was investigated. Analyses of sequences were used to compare human and environmental genotypes. A total of 40 stool specimens, 12 samples of untreated urban sewage, 12 samples of treated urban sewage and 12 samples of surface water were analysed. Viruses were concentrated from water samples by the tangential flow ultrafiltration technique. The presence of HEV RNA was detected by nested RT-PCR. Viral isolates were sequenced and phylogenetically characterized. Two (5%) of the 40 faecal samples tested were found to be positive for HEV RNA (G1 and G3 genotypes). The virus was detected in 25% (3/12) of the untreated sewage samples and 25% (3/12) of the surface water samples: all isolates belonged to G3 genotype. None of the treated sewage samples were found to be HEV RNA positive. The virus was detected in the faeces of two asymptomatic subjects, suggesting a potential role for symptom-free HEV carriers as a human reservoir. G3 HEV strains were detected in the untreated sewage, as observed in similar studies conducted in other European countries but differing from another study conducted in Italy recently. Moreover, our results show the first case of HEV isolated from fresh surface waters.

Stinging jellyfish outbreaks represent a health hazard, causing contact dermatitis and systemic reactions. This study investigated the epidemiology, severity, and treatment protocols of jellyfish stings in a coastal area with high tourist development and frequent stinging jellyfish outbreaks of the central Mediterranean (Salento, Southern Italy), and the associated costs for the Italian National Health Service. In 2007–2011, 1,733 bathers (mostly children and females) sought medical assistance following jellyfish stings, the main cause of human pathologies due to contact with marine organisms. The majority of events were reported in the years 2007–2009, whereas the occurrence of cnidarian jellyfish outbreaks has been increasingly reported in the same area since summer 2010. Most symptoms were limited to local and cutaneous reactions; conversely, 8.7% of cases evoked complications, mainly due to allergic reactions. The main drugs used were corticosteroids, locally applied and systemic (46% and 43%, respectively), and with ammonia (74%) as the main non-pharmacological treatment. The estimated cost of jellyfish-related first-aid services along the Salento coastline over the 5-year period was approximately 400,000 Euros. Therefore the management of jellyfish outbreak phenomena need coordinated research efforts towards a better understanding of underlying ecological mechanisms, together with the adoption of effective prevention policy, mitigation strategies, and appropriate planning of health services at tourist hot spots.

Background: General and visceral adiposity are metabolic conditions associated with a state of chronic inflammation. In HIV1+ patients, visceral adiposity (VO) is a serious complication that predisposes to an increased risk of cardiovascular diseases. IL-17 has been associated with induction of tissue inflammation by up-regulation of IL-23. The aim of this study was to evaluate the role of IL-17 in visceral tissue in HIV1+ patients. Methods: eighty-two HIV1+ patients (41 with VO, Group-A; 41 without VO, Group-B) and 32 HIV1- controls (22 with VO, Group-C; 10 without VO, Group-D) receiving Highly-Active-Antiretroviral-Therapy (HAART) for more 12 months, were enrolled. Sonographically measured Perirenal Fat Diameter/Body Mass INdex was used to assess thickness of visceral adipose tissue using 3.75MHz convex probe. A value >0.22 was considered an index of central obesity. Metabolic parameters as well as IL-17 and IL-23 levels were measured. The association of IL-17 with PRFD/BMI and IL-23 was analyzed. Results: IL-17 serum levels in HIV1+ patients were significantly greater than those in control (837.86±260.06 pg/mL vs 377.36±144.76 pg/mL, p<0.001). IL-17 serum levels in Group A and C were lower than those in Groups B and D (756.98±282.98 and 344.44±138.94 vs 918.74±208.47 and 449.77±136.62 respectively; p<0.001) (Figure 1). For all subjects a statically significant positive correlation between IL-17 and IL-23 was found (r=0.7504; p< 0.0001). Conclusions: Our preliminary data could confirm a pro-inflammatory role of IL-17 in immune and adaptive response to host defense. The findings suggest a potential implication for IL-17 in obesity and describe emerging data regarding the role of IL-17 in adipogenesis.

Hypoestrogenism in postmenopausal women results in skin atrophy with a decrease in both elasticity and skin thickness. The fragility of the skin in aging women may be responsible for the reported 50% or more increase in major laparoscopic complications during the initial entry into the female abdomen. Several first-entry techniques in laparos- copy have been investigated to minimize entry-related complications. The Veress needle approach is the standard method used by most gynecologists. A promising new method is the direct optical access (DOA) which uses optically-guided trocars to provide visual guidance during entry. These 2 techniques have not been compared. The aim of this prospective randomized study was to evaluate the efficacy and safety of these 2 methods in postmenopausal women. The study was conducted at multiple European gynecology centers between 2004 and 2008. A total of 186 postmenopausal women scheduled to undergo laparoscopy for simple, persistent postmenopausal ovarian cysts were randomized to 2 groups: group I (n = 89) was assigned to surgical entry using DOA, and group 2 (n = 97) was assigned to entry using the Veress needle method. The 2 procedures were compared for the following parameters: the time needed for achieve adequate abdominal access, the occurrence of major and minor vascular and bowel injuries, and blood loss during laparoscopic access. The time needed to establish adequate abdominal access was significantly reduced in the DOA access group compared to the Veress group (65.7 ± 11.9 vs. 192.8 ± 5.6 minutes; P < 0.0001), but there were no significant differences between the two groups in the occurrence of major vascular and/or bowel injuries (P = NS). Although fewer minor vascular injuries were found with DOA method than the Veress technique (1 versus 3), the difference was not statistically significant. The findings of this small preliminary study suggest that use of the DOA technique may be a safe and less time-consuming approach to abdominal entry in postmenopausal women and may avoid the risks of blind access laparoscopy.

Objective The aim of the study was to evaluate the interleukin-17 (IL-17) plasma level in HIV-1-infected patients and its relation to central obesity. Methods Eighty-four HIV-1-infected patients [42 with visceral obesity (group A) and 42 without visceral obesity (group B)] and 46 HIV-negative subjects [23 with visceral obesity (group C) and 23 without visceral obesity (group D)] were enrolled in the study. Sonographic measurements of perirenal fat diameter/body mass index (PRFD/BMI) were used to assess visceral adipose tissue thickness. Results HIV-1-infected patients had higher plasma levels of IL-17 than HIV-negative subjects [837.8 ± 260 pg/mL (mean ± standard deviation) vs. 395.3 ± 138.6 pg/mL, respectively; P < 0.001]. Furthermore, HIV-1-infected patients with a diagnosis of visceral obesity had lower levels of IL-17 than HIV-infected lean patients (756.9 ± 282.9 pg/mLvs. 918.7 ± 208.4 pg/mL, respectively; P < 0.01). IL-17 (r = −0.21; P = 0.03) and waist circumference (r = 0.48; P < 0.001) were significantly associated with visceral adipose tissue thickness. A negative correlation of IL-17 (r = −0.23; P < 0.001) with PRFD/BMI was found. Conclusions This study suggests a linear negative association between IL-17 and visceral adipose tissue thickness.

OBJECTIVE: The primary goal of this study was to determine the ultrasonographic signs of asynclitic and transverse head positioning. In addition, we compared the performance of intrapartum ultrasound to vaginal digital examination. MATERIAL & METHODS: 150 women were evaluated by 2D transabdominal and translabial ultrasound (US) to detect the asynclitic and deep transverse positions. Transvaginal sterile digital examinations were performed immediately after each intrapartum US assessments, the examinations were repeated at intervals of 45-90 minutes. Examiners were blinded to each other's findings (clinical or sonographic). Data were reviewed and analyzed by an independent reviewer. RESULTS: The efficacy of digital examination was significantly lower than US evaluation for the detection of either transverse position or asynclitism. The most frequent transverse position was the left one, while the most frequent asynclitism was the anterior one. CONCLUSIONS: Digital pelvic examination for detection of fetal head transverse position during labor is inferior to US, especially in the deep transverse positioning, where caput succedaneum occurs and reduces the diagnostic accuracy of vaginal digital examination. The US examination leads to early detection of persistent transverse position allowing for earlier timing and optimal technique for the operative vaginal delivery. We describe two signs for diagnosing asynclitism. The "squint sign" and the "sunset of thalamus and cerebellum signs" are two simple US signs allowing detection of anterior and posterior asynclitism.

Abstract. – Aim: To evaluate the incidence of occiput posterior position in labour with and without combined spinal epidural analgesia (CSE) by low dose of sufentanyl and ropivacaine. Material and Methods: This study focused on 132 women subdivided in two groups, patients in spontaneous and in labour analgesia, administered by a low dose CSE by sufentanyl and ropivacaine; all women were evaluated by digital examinations and ultrasound till delivery. All data were collected and analyzed by an independent reviewer. Results: In the second stage, 79 were persis- tent occiput posterior position (POPP) fetuses and 36 were translated from anterior to posterior position (TAPP) fetuses. Specifically, in sponta- neous labour on 25 women in anterior position, there were 17 TAPP and in CSE analgesia on 28 women in anterior, there were 19 in TAPP, with- out significant differences. The number of asyn- clitisms was higher in the POPP group (84%) re- spect to the TAPP group (75%), so as the rate of caesarean section (67% versus 52.7%). Conclusions: The labour with low dose of ropi- vacaine and sufentanyl does not increase the oc- ciput posterior position during fetal descent, lead- ing to a POPP. Finally, since in the occiput anterior presentation labour analgesia significantly length- ens time to delivery, in the occiput posterior posi- tion this is significantly increased, with a pro- longed second stage of labour and reduced time of descent of fetal head in obstetric pelvis.

Abstract. – Purpose: To investigate if early epidural analgesia can influence fetal head engage- ment into the pelvis and if it can increase the rate of transverse and asynclitic position during labour. Materials and Methods: 195 women with combined spinal-epidural analgesia (CSE) or with- out neuraxial analgesia were studied. CSE was performed using a mixture of ropivacaine 0.02% with 0.3 μg/ml of sufentanil administered in the spinal space. Maintenance of analgesia was man- aged with intermittent epidural administration of 10-15 ml of ropivacaine (0.07%-0.10%) mixed with 0.5 μg/ml of sufentanil, based on the stage of labour and the degree of pain. 2D transabdominal ultrasound (US) was used. Serial transabdominal US examinations were performed at 45-90 min in- tervals to detect transverse and asynclitic posi- tions, using the following signs: squint sign, sun- set thalamus and cerebellum signs that best de- tails the fetal head station. After delivery, the com- plete set of clinical and US data obtained by each examination were recorded and compared in women with and without labour analgesia. Data were examined by independent reviewers. Results: There was no difference in obstetric outcome between women in whom CSE had been used and those who did not request anal- gesia during labour (p>0.05). Conclusions: Epidural analgesia initiated early during labour and using low doses does not in- crease the rate of dystocic labors. Transverse fetal head positioning with anterior or posterior asyn- clitism does not seem to be promoted by drug or technique-related mechanisms, but rather should be the consequence of cephalopelvic disproportion.

Purpose of the study There is concern that human immunodeficiency virus (HIV) infection and the use of highly active antiretro- viral therapy lead to cumulative toxicity. Tenofovir (TDF) is the first choice for most subjects. Even if it has a safe metabolic profile, much attention has been fixed on kidney tubular function and regulation of phosphate metabolism. We performed this study to evaluate the role of a TDF based regimen has on renal tubular over time. Methods Prospective, cross-sectional, single centre study was car- ried out. 121 HIV-1-infected patients were consecutively enrolled in six groups based on duration of TDF exposi- tion: G0, from 6 to 12 months; G1 from 13 to 24 months; G2 from 25 to 36 months; G3 from 37 to 48 months; G4 more than 48 months and G5 under HAART but never exposed to TDF. Glomerular func- tion was assessed using creatinine clearance (CrCL) cal- culated by MDRD. Tubular function was assessed using fractional excretion ratio of phosphate and normalized renal threshold phosphate concentration. Demographic, CD4, serum phosphate levels, viral load were collected. Summary of results A total of 121 consecutive HIV-1-infected patients were analyzed: 15 in G0, 11 in G1, 14 in G2, 32 in G3, 35 in G4 and 14 in G5. Mean of TDF exposure was 10.26, 21.4, 36.2, 47.3 and 67.4 months in G0, G1, G2, G3 and G4 respectively. There was no statistically significant dif- ference of mean values of FEP(11.2, 10.3, 8.4, 9.8, 11.1 and 10% in G0, G1, G2, G3, G4 and G5 respectively), TmPO4/GFR (3.5, 3.5, 3.6, 3.6, 3.4 and 3.4 mg/dl in G0, G1, G2, G3, G4 and G5 respectively ), CrCL (102.2, 94.3, 92.9, 106.5, 103.1 and 101.6 ml/min/1.73m2 in G0, G1, G2, G3, G4 and G5 respectively) and serum phos- phate levels (3.4, 3.3, 3.1, 3.5, 3.3 and 3.4 in G0, G1, G2, G3, G4 and G5 respectively) between groups. Moreover, we did not find correlation of FEP (r:0.04, p:0.6) and TmPO4/GFR (r:0.05, p:0.5) with duration of TDF therapy. Conclusions Treatment with TDF is not associated with altered kid- ney tubular function and serum phosphate levels over time.

background: Our aim was to assess surgical complaints and reproductive outcomes of laparoscopic intracapsular myomectomies by a prospective observational study run in University affiliated hospitals. methods: Between 2005 and 2010, 235 women underwent subserous and intramural laparoscopic myomectomy of fibroids (4–10 cm in diameter) for indications of pelvic pain, menstrual disorders, a large growing myoma or infertility. The main outcome measures were post- surgical parameters, including complications, the need for subsequent surgery or symptomatic relief, resumption of normal life and repro- ductive outcome. results: Pelvic pain occurred in 27%, menorrhagia or metorrhagia in 21%, a large growing myoma in 10% and infertility in 42% of women. Single fibroids occurred in 51.9% of patients while 48.1% had multiple myomas. Of all patients, 58.2% had subserosal and 41.8% had intra- mural myomas. No laparoscopies were converted to laparotomy. In 3 years, 1.2% of patients had a second laparoscopic myomectomy for recurrent fibroids. The mean total operative laparoscopic time was 84 min (range 25 – 126 min), with mean blood loss of 118 + 27.9 ml. By 48 h after surgery, 86.3% were discharged with no major post-operative complications. No late complications, such as bleeding, urinary tract infections or bowel lesions, occurred. Of the women who underwent myomectomy for infertility, 74% finally conceived. At term, 32.9% of patients underwent Caesarean section, 24.8% delivered by vacuum extractor and 42.2% had spontaneous deliveries. No case of uterine rupture occurred. conclusions: Intracapsular subserous and intramural myomectomy saving the fibroid pseudocapsule showed few early and no late surgical complications, enhanced healing by preserving myometrial integrity and allowed a good fertility rate and delivery outcome. In young patients suffering fibroids, laparoscopic intracapsular myomectomy is a potential recommended surgical treatment.

Abstract Background: The background of this investigation is based on a common surgical problem:The access in laparoscopic surgery is more difficult in women with previous abdominopelvic surgery, since adhesions and viscera could be close to the point of trocar insertion. Purpose: The authors analyzed the safety and the efficacy of a modified direct optical entry (DOE) method versus the Hasson’s method by open laparoscopy (OL) in women with previous abdominopelvic surgery in a preliminary prospective case–control study. Materials and methods: A total of 168 women underwent laparoscopic surgery in university-affiliated hospitals: 86 were assigned to abdominal DOE (group A) and 82 to OL (group B).The main outcome measures were statistically compared: time required for entry into abdomen, blood loss, and occurrence of vascular and/or bowel injury.All patients had an intraperitoneal view of the primary port site during surgical procedure. Results: Statistical differences, in favor of the DOE group (P < .01), were found in duration of entry and blood loss.The vascular and bowel injuries in OL versus DOE were not statistically different. Conclusions: Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in patients with previous abdominopelvic surgery, since it can become a difficult, time-consuming, and occasionally hazardous procedure. The study results suggest that DOE is advantageous when compared with OL in terms of saving time enabling a safe and expeditious visually guided entry for laparoscopy.

Lifestyles profoundly determine the quality of an individual's health and life since his childhood. Many diseases in adulthood are avoidable if health-risk behaviors are identified and improved at an early stage of life. The aim of the present research was to characterize a cohort of children aged 6-8 years selected in order to perform an epidemiological molecular study (the MAPEC_LIFE study), investigate lifestyles of the children that could have effect on their health status, and assess possible association between lifestyles and socio-cultural factors.

Purpose of the study Hypophosphatemia may contribute directly to the devel- opment of obesity, hypertension and dyslipidemia. Hyperglycemia, insulin resistance, hyperlipidemia and hypertension, which are components of metabolic syn- drome, are also recognized as strong risk factors for car- diovascular disease [1]. This study was performed to determine whether serum phosphate levels are asso- ciated with increased risk for cardiovascular events. Methods We enrolled 125 consecutive HIV-1-infected patients in a cross-sectional study. All patients were receiving highly active antiretroviral therapy (HAART) for more than six months. Fasting phosphate, lipids (cholesterol, HDL, triglycerides), Homeostasis Model Assessment (HOMA), blood pressure were evaluated. Framingham 10 years risk of general cardiovascular disease was used to assess three cardiovascular risk (CVR) categories (low CVR < 10%, medium CVR between 10 and 20%, high CVR > 20%). Summary of results We observed a statistically significant decrease in serum phosphate levels in the three different CVR groups (low risk: 3.5 mg/dl; medium risk: 3.3 mg/dl; high risk: 2.9 mg/dl; p=0.001). There was a strong negative correlation between Framingham score and phosphate levels (r:- 0.37, p<0.0001). Figure 1 Multiple regression analysis, including age, months of HAART, CD4 cells count, cholesterol, HDL, HOMA, systolic pressure, months of Tenofovir use, showed that only HOMA (r:-0.30, p<0.01) and age (r:-0.3, p<0.01) were the most important determinants of serum phos- phate values. Conclusions We found that lower phosphate level is correlated with cardiovascular risk and insulin resistance. Therefore, when serum phosphate levels are too low the patients is at risk for cardiovascular events and/or metabolic syndrome.

Objective: Lymphoceles are among the most common postoperative complications of pelvic lymphadenectomy (PL), with a reported incidence of 1% to 50%. Symptoms are pelvic pain, leg edema, gastrointestinal obstruction, obstructive uropathy, and deep vein thrombosis, and severe complications such as sepsis and lymphatic fistula formation. After laparoscopic PL, we tested the prevention of lymphoceles using collagen patch coated with the human coagulation factors (TachoSil) on 55 patients with endometrial cancer stages IB to II who had undergone laparoscopy. Materials and Methods: The authors divided the patients into 2 laparoscopy groups: PL plus TachoSil (group 1: 26 patients) and PL without TachoSil in a control group (group 2: 29 patients), as historical cohort of patients who underwent PL between 2010 and 2012. We collected surgical parameters, and the patients underwent ultrasound examination on postoperative days 7, 14, and 28. The main outcome measures were the development of symptomatic or asymptomatic lymphoceles, the need for further surgical intervention, as adverse effect of surgery, and the drainage volume and duration. Results: The same number of lymph nodes in both groups was removed; group 1 showed a lower drainage volume. Lymphoceles developed in 5 patients in group 1 and in 15 patients in group 2; of these, only 2 patients were symptomatic in group 1 and 5 patients were symptomatic in group 2, without statistical difference and no percutaneous drainage request. Conclusions: In this preliminary investigation, the intraoperative laparoscopy application of TachoSil seems to reduce the rate of postoperative lymphoceles after PL, providing a useful additional treatment option for reducing drainage volume and preventing Ls development after PL.

Aquaculture is an enterprise in constant development, in particular relating to its effect on the environment and also the quality of its products. It represents a valid alternative to traditional fishing, facing the increasing demand for fish products. To guarantee to the consumer a product of high nutritional, organoleptic and hygienic quality, it is fundamental to monitor every phase of the fish farming industry, isolating the potential risk points. For this reason there has been a rapid evolution of productive technique, particularly in the technology, artificial reproduction and feed sectors. The aim of this research has been the monitoring of the evolution of certain microbial and nutritional quality indexes (total microbial counts and lipid analysis on suspensions of Rotifers and Artemia, used as live feed) in the larval phase of the productive cycle of the farm raised fish, in an intensive system. The study has shown an increment in the total microbial counts in the fish farming industry within the production of Rotifers and Artemia, more evident in the suspensions of Rotifers. In addition the study has demonstrated that the maintenance phase, in the enrichment protocol, can reduce the EPA and DHA content. The results confirm the importance of microbial and nutritional control of the live feeds before they get supplied to fish larvae.

Introduction. Sepsis is a major cause of significant morbidity and mortality in neutropenic patients. Blood culture remains the gold standard in the microbiological diagnosis of bacterial or fungal bloodstream infections, but it has clear limits of rapid- ity and sensitivity. The objective of the study was to compare the real-time polymerase chain reaction (RT-PCR) with auto- mated blood cultures (BC) method in detection in whole blood of pathogens in febrile neutropenic patients with hematological malignancies. Methods. A total of 166 consecutive febrile neutropenic patients were enrolled. Blood samples for cultures and SeptiFast testing were obtained at the onset of fever, before the implementation of empirical antibiotic therapy.

Introduction: The human papillomavirus (HPV) family is characterized by minimal geno- typic differences corresponding to different virus types. The aim of this study was to detect the HPV coinfections and the inner genotype in a series of 336 cervical-vaginal samples. Methods: A total of 336 cervical-vaginal samples were taken from 2007 to 2009 using specific molecular techniques such as molecular sequencing and hybridizations. The ge- nome amplification of the L1 open reading frame was analyzed by real-time polymerase chain reaction; direct sequencing was performed by SYBR green fluorescent molecule and degenerate primers MY09 and MY11. The HPV genotyping was accomplished via oli- gonucleotide probe hybridization. The phylogenetic correlations in coinfections were an- alyzed by sequence homology of the L1 genomic region. Identified genotypes were then compared. Results: Human papillomavirus positivity was observed in 125 cases (37.2%), with 21 cases (16.8%) of HPV presence in coinfections. Coinfections involved HPV 16 geno- type (8 cases) and HPV 18 (5 cases). The HPV 16 infection was mainly associated with genotypes with a lower-than-broad sequence homology, so the HPV 18 was linked to genotypes represented in the opposite phylogenetic tree. Conclusions: The combined and steady use of diagnostic procedures, such as real-time polymerase chain reaction, molecular hybridization, direct sequencing, and HPV geno- typing test, allow accurate diagnosis of monoinfections and coinfections. This may faciliate the development of specific viral tests and prophylactic anti-HPV vaccines.

Introduzione L'inquinamento atmosferico rappresenta una delle più rilevanti cause di malattia in tutto il mondo. Diversi studi hanno trovato un'associazione consistente tra l'esposizione all'inquinamento atmosferico, soprattutto al particolato, e l'incidenza di diverse malattie croniche come il cancro al polmone, le malattie cardiovascolari e il diabete. Tra i meccanismi responsabili di questi effetti negativi, il danno genotossico è particolarmente importante. Anche se l'intera popolazione è esposta all'inquinamento atmosferico, alcune categorie, in particolare i bambini, hanno un rischio maggiore di subire le conseguenze delle sostanze tossiche disperse nell'aria. Dati recenti suggeriscono che le alterazioni genetiche che si verificano nei primi anni di vita possono aumentare il rischio di cancerogenesi in età adulta. I biomarcatori di danno genetico sono stati studiati in gran parte della popolazione adulta, ma solo pochi studi finora sono stati condotti sui bambini esposti all'inquinamento atmosferico. L'obiettivo dello studio MAPEC_LIFE (Monitoring Air Pollution Effects on Children for Supporting Public Health Policy) [1] è di valutare l'associazione tra la concentrazione di alcuni inquinanti atmosferici e gli effetti biologici precoci in bambini residenti in cinque città italiane (Brescia, Torino, Lecce, Perugia and Pisa) caratterizzate da differenti livelli di inquinamento atmosferico. Gli autori presentano i risultati del test dei micronuclei (MN) condotto sulle cellula della mucosa orale dei soggetti residenti a Lecce in relazione agli stili di vita e a fattori associati all'esposizione indoor/outdoor comprendenti il livello di PM10 e PM0,5, il contesto familiare e residenziale, l'attività fisica e lo stato ponderale.

Abstract: Persistent infection of High Risk (HR) Human papillomavirus (HPV) infection can lead to cervical cancer. The HPV genotypes are found worldwide, but important regional variations have been found. For a population-based HPV type prevalence study to assess the effect of existing and new prevention methods, frequently updated information on thè burden of cervical cancer is essential. We evaluated thè prevalence of HPV genotypes in a volunteer population screened for cervical cancer at the Local Health Unit (LHU) of Lecce. A total of 9,720 women were studied. The tests were performed by INNO-Lipa HPV genotyping and LINEAR ARRAY HPV Genotyping Test. The overall HPV prevalence was 29.7% (95% CI, 28.8-30.6) for any HPV DNA. The prevalent type for ali age groups was HPV 16 (7.4%; CI, 6.9-7.9) followed by HPV 31 (3.4%; CI, 3.0-3.7), 51 (3.0%; CI, 2.6-3.3), 52 (2.7%; CI, 2.3-3.0) and 58 (2.4%; CI, 2.1-2.7). HPV 53 was thè most common low-risk HPV type with prevalence rate of 3.5 (CI, 3.1-3.8), followed by HPV 66 (3.0; CI, 2.6-3.3), 6 (2.9; CI, 2.6-3.2) and 42 (2.5; CI, 2.2-2.8). Multiple infections were present in 13.6% of HPV-tested women (CI, 12.9-14.3). Among these, thè most common combination was of HPV 16 and HPV 52 genotypes. This study reports high prevalence of HPV infection and may serve as a valuable reference for assessing thè impaci of HPV vaccination programs. Furthermore, it supports the need for new vaccines that contain the most common HPV genotypes present in the population.

Background and Objectives: The prevention of lymphoceles was tested using collagen patch coated with the human coagulation factors (TachoSil) on 58 consecutive patients with endometrial cancer who had undergone hysterectomy and pelvic lymphadenectomy (PL). Methods: Patients were randomized in two groups: standard technique plus TachoSil (30 patients, group 1) and standard technique only (28, group 2). All surgical parameters were collected and patients underwent ultrasound examination on postoperative days 7, 14, and 28. The main outcome measures were: the development of symptomatic or asymptomatic lymphoceles, the need for further surgical intervention, as adverse effect of surgery and the drainage volume and duration. Results: Same number of lymph nodes in both groups was removed; group 1 showed a lower drainage volume. Lymphoceles developed in 7 patients in group 1 and 16 in group 2, but only 3 were symptomatic in group 1 and 9 symptomatic in group 2, with statistical difference. Percutaneous drainage proved necessary in five cases: only one was in group 1 and four in group 2. Conclusions: Intraoperative application of TachoSil reduced rate of postoperative lymphocysts after PL, and it seems to provide a useful additional treatment option for reducing drainage volume and preventing lymphocele development after PL.

A. annua was usually used to prepare a tea and if it contains effective amounts of artemisinin, it might be used today as a self-reliant treatment of malaria [1]. Artemisia annua tea has proven itself to be a very effective treatment for malaria in various clinical trials, but to date, his efficacy has not been investigated in vitro. Therefore, we have carried out a study for the evaluation of effects of A. annua tea on Plasmodium falciparum cultures in vitro. We also determined the concentration of artemisinin in herbal tea preparation. The compound was tested against chloroquine-sensitive D10 and chloroquine-resistant W2 strains of P. falciparum using the parasite lactate dehydrogenase assay [2]. The quantification of artemisinin in the extract of leaves of A. annua was obtained using an 1H NMR method. The in vitro tests conducted in this study confirm the clinical efficacy demonstrated by the tea of A. annua in vivo on both chloroquine-sensitive D10 and chloroquine-resistant W2 strains. The concentration of artemisinin in A. annua tea is lower with respect to that of pure artemisinin responsible for the same antimalarial activity. The artemisinin present in the tea is probably co-solubilised with other ingredients, some of which may also have antimalarial activity and act synergistically with it. The presence of other active ingredients suggests that A. annua is a natural artemisinin combination therapy. These compounds also merit further research, to see whether their presence hinders the development of parasite resistance compared to pure artemisinin [3]. [1] C.H.Blanke, G.B.Naisabha, M.B.Balema, G.M.Mbaruku, L.Heide and M.S.Muller, Trop. Doct., 38, 2008, 113–6. [2] M.T.Makler, J.M.Ries, J.A.Williams, J.E.Bamcroft, R.C.Piper, B.L.Gibbins, et al, Am.J.Trop.Med.Hyg., 48(6), 1993, 739-41. [3] Work supported by Regione Puglia Progetto Strategico PS70.

Problems affecting the vaginal tract in diabetic women are very often neglected. The efficacy and safety of three gynecological treatments in diabetic women have been assessed. Materials and Methods: A single-blind randomized progressive trial on 48 diabetic women affected by vaginal dryness, dyspareunia, and recurrent Candida infections was carried out. The ICIQ Vaginal Symptoms (ICIQ-VS) questionnaire was administered. Results: The analysis of the parameters of ICIQ-VS questionnaire among the three groups showed significant difference only for "dragging pain" (p = 0.019) and "soreness" (p = 0.028). In all groups and for all parameters of the questionnaire, improvement of symptoms was observed. In particular, in Group 1 for all symptoms a highly significant difference was observed, to support the already known benefits of the products and of the proposed combination. Significant improvement was also observed in Group 2. Conclusions: The proposed treatment with DermoXEN® Ultracalming Special for diabetics and DermoXEN® Vitexyl vaginal gel exert effective moisturizing and soothing action. Indeed, the aforementioned products have been proven effective for the main gynecological problems of diabetic women.

Semeiotica è un termine di derivazione greca e significa “segno”, che resta il cardine di qualsiasi processo diagnostico. Alla Semeiotica Ostetrica, a differenza di quella Medica e Chirurgica, non è stato riservato uno spazio specifico nella editoria, neanche in tempi moderni dove l'introduzione di nuove e diverse tecnologie ha ampliato il corredo sintomatologico e le possibilità diagnostiche in Ostetricia. Anzi l’editoria degli ultimi decenni ha prodotto diversi testi su tecniche e metodologie specifiche, che pur meritando l’attenzione dovuta, restano una parte dell’intero processo diagnostico. Nel processo diagnostico, oggi ancor più, appare importante coniugare i sintomi ed i segni classici della semeiotica ostetrica con i segni che più recentemente sono venuti affermandosi con l'utilizzo delle tecniche strumentali, come ad esempio l'ecografia e la cardiotocografia, per far riferimento a due metodologie comunemente impiegate nella pratica clinica quotidiana. La ricerca dei segni va praticata sulla gestante ed il feto, come processo unitario, evitando, quando possibile, di assegnare eccessiva importanza ad una tecnica in particolare nell'intero processo diagnostico. Le metodologie diagnostiche restano comunque un mezzo, da impiegare opportunamente nei casi richiesti, e partecipano con la semeiotica clinica al fine comune che è rappresentato dal processo diagnostico.

The surveillance and monitoring of rotavirus (RV)-related diseases, preferably through the establishment of sentinel surveillance sites, are essential for assessing the need for vaccination and the projected results of the vaccine in terms of reducing the burden of disease. The objective of the present study was to compare RV strains isolated in Northern (Ferrara) and Southern (Galatina-LE) Italy. During 2007–2008, 115 RV-positive stool samples were collected from children with diarrhea admitted to the hospitals of Ferrara and Galatina. The specimens were genotyped for VP7 (G-type) and VP4 (P-type) gene by reverse transcription (RT) and multiplex polymerase chain reaction (PCR). A subset of 21 RV strains was randomly selected and characterized by sequence analysis of the VP7 genes. In total, seven G/P combinations (G1P[8], G2P[4], G4P[8], G9P[8], G2P[8], G1P[9], and G2P[10]) were identified. Phylogenetic comparison of the VP7 encoding gene of selected strains showed that there was similarity among RV strains circulating in Northern and Southern Italy. The observation of nucleotide sequence diversity contributes to a better understanding of RV spreading and helps to characterize the various antigenic shifts that could have an impact on vaccine effectiveness.

A serological survey was performed to determine the prevalence of antibodies against human bocavirus in Apulian population. Anti-hBoV IgG antibodies were analyzed in 1,206 inhabitants (Age range: 1 month-84 years) using a standardized ELISA test based on the use of recombinant hBoV VP2 virus-like particles. In total, 1,075 (89.1%) of 1,206 participants (mean age 32±24.8 yrs) displayed anti-hBoV-IgG. The seroprevalence increased significantly (p<0.0001) in children from 2-4 yrs (64.2%) to 5-9 yrs (96.4%). A similar trend was observed in both males and females. In conclusion, our results show that hBoV infection is common in population, especially in children.

Abstract Objective. To compare cesarean section (CS) using open or closed visceral peritoneum of the bladder flap (BF) in relation to fluid collection in vesico-uterine space (VUS) by ultrasound (US) and clinical outcome. Material and methods. A prospective cohort of repeat CS in 474 in advanced first and second stage of labor was studied. All women underwent a Misgav Ladach CS, in local combined anesthesia. These were divided into two groups by surgical management of the BF at the time of CS: Group I (n = 262), with visceral peritoneum left open and Group II (n = 212), with visceral peritoneum closed. An US check for the fluid collections in the VUS was done in the third post-operative day. The two groups were also clinically compared for: intra-operative estimated blood loss, the need for post-CS pain killers, febrile morbidity and duration of hospital stay. Results. Visceral peritoneum (VP) closure resulted in a significant increase blood collections in the VUS (p < 0.05). VP closure resulted in a significantly higher morbidity in all the following parameters. Rate of BFHs, post-operative fever, need for post-operative analgesia, require antibiotic administration and prolonged hospitalisation (p < 0.05). Conclusions. VP suturing of women requiring CS for dystocia is associated to increased rate of blood collection in the VUS, which could possibly explain the higher rate of puerperal complications in these patients. These data clearly indicate that suturing the VP of the BF in women undergoing CS for dystocia is contraindicated. This data could be probably extrapolated to all cesarean deliveries.

ABSTRACT Purpose. The aim of our study was to evaluate whether perirenal fat thickness (PRFT), a pa- rameter of central obesity, is related to carotid intima- media thickness (IMT), an index of atherosclerosis in human immunodeficiency virus (HIV)-1-infected patients. Methods. We enrolled 70 consecutive HIV-1- infected patients receiving highly active antiretroviral therapy for more than 12 months, in a prospective cohort study. Sonographically measured PRFT and carotid IMT, as well as serum metabolic parameters, were evaluated. PRFT and IMT were measured using 3.75-MHz convex and 7.5-MHz linear probes, respec- tively. Results. The mean PRFT and IMT in HIV-1-infected patients with visceral obesity was significantly greater than those in patients without it (p < 0.0001 and p < 0.01, respectively). Using the average IMT as the dependent variable in regression analysis, PRFT was an independent factor associated with ca- rotid IMT (p < 0.05). A PRFT of 6.4 mm was the most discriminatory value for predicting an IMT ! 0.9 mm (sensitivity 83.3%, specificity 83.9%). Sub- jects with visceral obesity had a progressively increasing carotid IMT on the 12-month measure- ment (p < 0.05). Conclusion. Our data demonstrated that PRFT mea- surement could be used as an early predictor of IMT increase in HIV-1-infected patients receiving highly active antiretroviral therapy.

The aim of this study was to evaluate the presence of influenza virus co-infections in humans and changes in the genetic variability of A(H3N2) virus strains in southern Italy from 1999 to 2009. A partial sequence of the haemagglutinin (HA) gene by human influenza H3N2 strains identified in oropharyngeal swabs from patients with influenza-like illness was analysed by DNA sequencing and a phylogenetic analysis was performed. During the seasons 1999–2000, 2002–2003, 2004–2005 and 2008–2009, the influenza viruses circulating belonged to subtype H3N2. However, A(H1N1) subtype virus and B type were respectively prevalent during the 2000–2001, 2006–2007, 2007–2008 and 2001–2002, 2003–2004, 2005–2006 seasons. The HA sequences appeared to be closely related to the sequence of the influenza A vaccine strain. Only the 2002–2003 season was characterized by co-circulation of two viral lineages: A/New York/55/ 01(H3N2)-like virus of the previous season and A/Fujian/411/02(H3N2)-like virus, a new H3 variant. In this study, over the decade analysed, no significant change was seen in the sequences of the HA gene of H3 viruses isolated.

Background: Varicella is predominantly a childhood disease, considered a mild self-limiting disease that can have serious complications for a pregnant woman and her developing fetus. Objectives: We investigated the susceptibility to varicella-zoster Virus (VZV) among pregnant women in the province of Lecce. Study design: A cross-sectional study was carried out in Departments of Gynecology and Obstetrics of the Province of Lecce, where 539 pregnant women were recruited, and face-to-face interviews were conducted. Varicella IgG tests were performed. Results: The prevalence of varicella susceptibility among pregnant mothers was 10.6%. The prevalence of IgG antibodies increases significantly with increasing age, from 62.5% in the age group 15–19 years to 94.4% in the age group 40–49 years. Discussion: In the Italian National Vaccination Plan 2005–2007, varicella vaccine is only recommended for childbearing women. A safe and effective vaccine is available and no abnormalities have been observed among infants born to susceptible women who received varicella vaccines during pregnancy. Such a high number of susceptible women indicates that preventive and informative programs should be introduced, even among those who do not plan to become pregnant. Routine counselling, varicella IgG antibody screening and varicella vaccination should be considered if they have no history of the infection, to reduce the risk of fetal complications and the cost of healthcare associated with the infection.

Some quinoline-based compounds bearing a ferrocenyl unit in the 2-position of the heterocyclic system were synthesized from ferrocenyl-o-nitrochalcones through a simple hydrogenation/intramolecular cyclization sequence and fully characterized. The obtained ferrocenyl derivatives were evaluated in vitro as antimalarial agents against chloroquine-susceptible D10 and chloroquine-resistant W2 strains of Plasmodium falciparum and a beneficial effect of the organometallic moiety was evidenced in comparison with the phenyl-substituted analogues. All the ferrocenyl heterocycles inhibited the parasite growth in mM range and the lowest values of IC50 were determined for derivatives containing a dimethylamino group as additional substituent.

Clinical and epidemiological surveillance of influenza and other Acute Respiratory Infections (ARI) are currently amajor objective of PublicHealth. The aim was to describe the epidemiology of influenza using the Italian surveillance system. Vaccination Coverage (VC) rates were calculated during 1999-2009 influenza seasons. Molecular studies of influenza virus isolated, from patients with ILI, living in Apulia, are described. 1269 nasal-pharyngeal swabs were taken from patients with ILI and ARI in order to isolate and identify viruses using PCR. Influenza isolates are typed as being types A and B and influenza A isolates are A/H1 and A/H3. The progression of the ILI cases registered in Apulia was similar to the data recorded on a national level. The VC data recorded in Apulia showed a progressive increase in the vaccine doses administered to subjects over 65 years old. The virological surveillance showed a major circulation of the type A/H3N2 influenza virus during the peak incidence of the illness in seasons 1999-2000, 2002-2003, 2004-2005 and 2008-2009. During the same period, the lowest incidence was registered when the type A/H1N1 and B viruses were in circulation. In contrast, during the other seasons the lowest incidence was reported with A/H3N2 and B viruses

Objectives: To evaluate the effect of bladder flap formation (BFF) during caesarean section (CS) on the uterine scar, assessed during repeat CS. Studydesign: OnehundredandfifteenwomenundergoingtheirfirstCSweredividedintotwogroups:58 women had a CS with BFF (Group 1) and 57 women had a CS without BFF (Group 2). During the repeat CS, four specimens from the uterine scar from the first CS were collected from each woman, and evaluated by light microscopy and transmission electron microscopy (TEM). Results: Adhesionswerefoundin28(48.3)womeninGroup1and14(24.1%)womeninGroup2(p<0.01). Of the women with adhesions in Group 1, 20 (71.4%) had mild adhesions and eight (28.6%) had severe adhesions. Of the women with adhesions in Group 2, eight (57.1%) had mild adhesions and six (42.9%) had severe adhesions. Light microscopy revealed significant differences in submesothelial fibrosis (39.6% vs 12.2%; p < 0.01) and neo-angiogenesis of the mesothelial stroma (46.5% vs 21%; p < 0.01) in Groups 1 and 2, respectively. TEM revealed more specimens with inflammatory cells in Group 1 compared with Group 2 {mean 29.7 [standard deviation (SD) 1.3] vs 18.2 (SD 1.9) patients; p < 0.01}. Conclusion: BFF during CS leads to an inflammatory and fibrotic reaction, resulting in inflammation reactive and regenerative processes, mesothelial hyperplasia and submesothelial fibrosis. CS without BFF reduces the inflammatory processes and the subsequent intraperitoneal adhesions and adhesions between the bladder and uterus.

Universal varicella vaccination in Sicily was introduced in infant population since 2003, with a rapidly increasing coverage. Aim of the present study was to analyze changes in the epidemiology of varicella since the introduction of universal vaccination.

Abstract: The biomolecular follow up of Human Papilloma Virus (HPV) is widely investigated in patients treated for HPV related cervical lesions, since the HPV-mRNA test is more specific and have a higher positive predictive value for CIN2-3 in triage of high risk (HR) women and in follow-up of women treated for CIN2/3. Material & Methods: we investigated, during a 5 years’ study, a cohort of patients divided in: group 1, patients at high risk for HPV-infections, and group 2, women diagnosed for CIN2/3, Cervicocarcinoma in situ (CIS) and Adenocarcinoma in situ (AIS) and surgically treated. The overall scheduled follow up was repeated each 6 months by: Pap Test, HPV-DNA test, m-RNA-HPV test and, in case of CIN2/3, CIS and AIS, also by colposcopy and biopsy. Results: The follow up involved a total of 203 women: 85 women with mRNA-HPV positive test and 118 patients surgically treated for CIN2/3, CIS and AIS. In the group 1, the long term follow up detected, after one year, 32 positive mRNA-HR HPV women and, of these, after more than 2 years, 37.5% developed CIN1 and 21.8% developed CIN2/3. Similarly, in the follow up of group two, women with abnormal Pap test showed positivity of mRNA HR-HPV in 71.4% of cases even after 6 months; 65% of these developed a CIN1 within 2.5 years and 20% had CIN2/3 after 2.3 years. Conclusions: Study results indicate either that patients with mRNA HR-HPV positive controls, on average, after 12 months are all at risk of progression to CIN1 and CIN2/3, or the higher specificity of mRNA-HPV test than Pap Test in follow up of surgical treated patients. This investigation confirmed a strong association between HR mRNA-HPV presence and risk of neoplastic progression.

Abstract Background: The introduction of highly active antiretroviral therapy (HAART) has dramatically changed the prognosis of human immunodeficiency virus (HIV) infection, with a significant decline in morbidity and mortality. Changes in body fat distribution are a common finding in individuals with HIV infection being treated with antiretrovirals, and this condition (collectively termed lipodystrophy syndrome) is associated with depletion of subcutaneous fat, increased triglycerides and insulin resistance. Obesity, particularly visceral obesity, is associated with increased risk of cardiovascular disease. Therefore, estimating visceral fat distribution is important in identifying subjects at high risk for cardiovascular disease. The aim of our study was to evaluate whether perirenal fat thickness (PRFT), a parameter of central obesity, is related to ophthalmic artery resistance index (OARI), an index of occlusive carotid artery disease in HIV-1 infected patients. Methods: We enrolled 88 consecutive HIV-1-infected patients receiving highly active antiretroviral therapy for more than 12 months, in a prospective cohort study. Echographically measured PRFT and OARI, as well as serum metabolic parameters, were evaluated. PRFT and OARI were measured by 3.75 MHz convex and 7.5 MHz linear probe, respectively. Results: The means of PRFT and OARI in HIV-1-infected patients with visceral obesity was considerably higher than in patients without it (p < 0.0001 and p < 0.001, respectively). Using the average OARI as the dependent variable, total serum cholesterol level, HDL, triglycerides, glycemia, sex, blood pressure, age and PRFT were independent factors associated with OARI. A PRFT of 6.1 mm was the most discriminatory value for predicting an OARI > 0.74 (sensitivity 78.9%, specificity 82.8%). Conclusions: Our data indicate that ultrasound assessment of PRFT may have potential as a marker of increased endothelial damage with specific involvement of the ocular vascular region in HIV-1-infected patients.

OBIETTIVI: Le scarse precipitazioni e l’assenza di riserve idriche superficiali, parallelamente alla crescente richiesta idrica nel settore civile e produttivo, hanno determinato, nelle aree centrali del Salento ed in particolare nella Grecia Salentina, l’incremento dello sfruttamento della falda profonda. Contemporaneamente si sono registrati fenomeni di antropizzazione del territorio individuabili nell’urbanizzazione delle zone rurali, nell’introduzione di tecnologie di produzione agricola sempre più intensiva e nell’industrializzazione, che sommati alla vulnerabilità intrinseca degli acquiferi profondi, hanno determinato un potenziale impatto negativo sulla qualità delle acque con possibili conseguenze sanitarie ed economiche. L’obiettivo dello studio è stato quello valutare lo stato microbiologico delle risorse idriche profonde nella Grecia Salentina e identificare eventuali criticità determinate da fattori di rischio presenti sul territorio. METODI: Il metodo di riferimento adottato in questo studio è stato il modello concettuale DPSIR secondo cui i fattori antropici (D) esercitano pressioni (P) sull’ambiente tali da modificarne lo stato di qualità (S) e produrre impatti negativi (I) sulla salute umana e sugli ecosistemi, per cui vengono richieste delle risposte (R) di tutela ambientale. Pertanto, oltre alla valutazione dello stato microbiologico delle risorse idriche profonde, sono stati presi in considerazione indicatori ambientali relativi a caratteristiche idrogeologiche, aspetti demografici, sociali ed economici, consumo idrico, produzione di fattori inquinanti, aspetti sanitari dell’ambiente e della popolazione, strategie di tutela dell’ambiente. RISULTATI E CONCLUSIONI: I risultati hanno evidenziato uno stato microbiologico eterogeneo riconducibile ad una contaminazione di origine fecale, elevata e diffusa in gran parte del territorio, durante l’estate e modesta e puntiforme nel corso delle altre stagioni. In alcune aree i fenomeni di degrado sono particolarmente evidenti a causa della presenza di fattori antropici che, in associazione alla vulnerabilità del territorio, determinano condizioni di pericolo tali da compromettere la salubrità delle risorse idriche: insediamenti abitativi extraurbani ad uso prevalentemente estivo, non serviti dalla rete fognaria; aree urbane con basso numero di allacci fognari; depuratori sottodimensionati; aree industriali. Lo stato sanitario delle acque profonde ne condiziona la loro fruibilità sia per scopi potabili che per quelli irrigui. Tali circostanze impongono la tempestiva realizzazione di interventi finalizzati al recupero della situazione di degrado e ripristino degli standards minimi di qualità ambientale.