G. Liguori

Rapid identification of Candida species in oral rinse solutions by PCR

Aims: To determine the sensitivity and specificity of a multiplex PCR assay for the contemporary identification of major species involved in oral candidiasis, without extraction and purification of DNA from the samples under investigation; and evaluation of this method in comparison with routine phenotypic culture identification. Methods: 78 oral rinse solutions were collected. The concentrated oral rinse technique was used for a quantitative and qualitative study. Research and identification of Candida spp, with routine phenotypic culture identification (germ-tube test in serum at 37°C for 3 hours and sugar assimilation strip analysis), were performed. Each sample was analysed with multiplex PCR directly on oral rinse solution. Samples giving discrepant results between routine phenotypic and PCR identification methods were resubcultured on CHROMagar Candida plates. The fungus-specific primers ITS1, ITS2, CA3, and CA4 were used. For the identification of other species (C kefyr, C famata and C dubliniensis), ITS1F, ITS1K, and ITS2D primers were designed. Results: Multiplex PCR correctly identified all samples, including those with single species, or with mixed species, negative samples and positive samples which appeared to be negative from routine phenotypic methods. Conclusion: This multiplex PCR assay provides a rapid alternative to the conventional culture based technique for the identification and speciation of the most frequently isolated Candida species. The absence of an extraction method made identification of 10 species possible in a few hours.

Oral candidiasis: a comparison between conventional methods and multiplex polymerase chain reaction for species identification

BACKGROUND/AIM Oral candidiasis is the most common fungal infection in dental practice, and is caused by yeasts that are normally present in the endogenous flora. METHODS To evaluate a rapid diagnostic method for identification of Candida oral isolates, a multiplex polymerase chain reaction (PCR) was carried out on colonies and on oral rinse solutions from 95 subjects with suspected oral candidiasis and results were compared with those from seven commonly used phenotypic identification systems. RESULTS Between four and nine species were characterized in the samples by the phenotypic methods. PCR identified the same species in 60 (74%) samples from both colony and oral rinse solutions. Statistical analysis, carried out only for the three most frequently isolated species (Candida albicans, Candida glabrata, and Candida tropicalis), showed good concordance in the comparison of multiplex PCR with API 20C AUX and with the Rapid Yeast Identification Panel; conversely, significant differences were registered in the comparison between the molecular method and other phenotypic systems, including four chromogenic media and the automated system Vitek2. DISCUSSION Multiplex PCR was rapid and effective in the identification of Candida species and allowed the detection of more than one species in the same sample.

Adult immunization with 13-valent pneumococcal vaccine in Campania region, South Italy: an economic evaluation.

Pneumococcal pneumonia has a high clinical burden in terms of morbidity, mortality and hospitalization rate, with heavy implications for worldwide health systems. In particular, higher incidence and mortality rates of community-acquired pneumonia (CAP) cases, with related costs, are registered among elderly. This study aimed to an economic evaluation about the immunization with PCV13 in the adult population in Campania region, South Italy. For this purpose we performed, considering a period of 5 y, a budget impact analysis (BIA) and a cost-effectiveness analysis which considered 2 scenarios of immunization compared with lack of immunization for 2 targeted cohorts: first, the high risk subjects aged 50–79 y, and second the high risk individuals aged 50–64 y, together with all those aged 65 y. Regarding the first group, the decrease of pneumonia could give savings equal to €29 005 660, while the immunization of the second cohort could allow savings equal to €10 006 017. The economic evaluation of pneumococcal vaccine for adult groups represents an essential instrument to support health policies. This study showed that both hypothesized immunization strategies could produce savings. Obtained results support the use of pneumococcal conjugate vaccine for adults. This strategy could represent a sustainable and savings-producer health policy.

Human papillomavirus infection and vaccination: Knowledge and attitudes among young males in Italy

ABSTRACT This study assessed knowledge and attitudes about Human papillomavirus (HPV) and the relative vaccination and their determinants in a sample of young males. The survey was conducted between January and April 2015 among a sample of 1000 males aged between 14–24 y in the geographic area of Naples and Caserta, Italy. The 54.9% of the participants reported of having heard about the HPV infection. Those who were aware about the availability of the vaccine, who reported the first vaginal sexual encounter before the 18 y and at least at 18 y compared to those who had not had a complete sexual intercourse, who had undergone a health checkup in the last year, and who had received information about the HPV vaccine by physicians had a significant higher knowledge about the HPV infection. The 58.2% reported that they would be willing to receive the HPV vaccine. Those younger, who reported the first vaginal sexual encounter at least at 18 y, who agreed that male should receive the vaccine, who knew that both males and females can acquire the infection, and who agreed that the vaccine is an important preventive intervention, expressed more positive attitude toward willingness to receive the vaccine. More information about the HPV vaccine were required by those who agreed that the vaccine is an important preventive intervention, who reported the first vaginal sexual encounter at least at 18 y, who have had only one partner in the last year compared to students who had no partner, and who had received information about the vaccine by physicians. This study highlights a need for improved education of young males of the HPV infection and the associated diseases and about the benefit of the vaccination.

Compliance with herpes zoster vaccination in young and adult individuals in two regions of Italy.

BackgroundThe purpose of this work was to explore the knowledge and acceptance of Varicella Zoster Virus (VZV)-Herpes Zoster (HZ) vaccination in the general Italian population, where the HZ vaccine has not yet been distributed, using a prevalence study of subjects from two regions in Italy.MethodsA group of 3,173 individuals were interviewed using a questionnaire. The youngest age group (≤ 20 year) was composed of students interviewed at university. The middle age group (21-40 years) and the older age group (≥ 41 years) were interviewed by general practitioners in their office.ResultsIn both regions, the majority of subjects had been infected with varicella, and only 165 (5.2%) subjects reported receiving the VZV vaccination. Regarding HZ, 2,749 (86.6%) individuals stated that they knew of the virus and 2,233 (70%) were willing to be vaccinated against HZ. The majority of people willing to be vaccinated were in the middle and older age groups (36.6% and 44.7%, respectively).ConclusionCompliance versus vaccination results were satisfactory and probably, with the upcoming availability of the HZ vaccine in Italy, adults will be favourably disposed towards vaccination.

Improving physical fitness and health status perception in community-dwelling older adults through a structured program for physical activity promotion in the city of Naples, Italy: A randomized controlled trial

To evaluate the efficacy and feasibility of a physical activity promotion intervention in community‐dwelling older adults based on a free program of exercise adapted for older adults aged ≥60 years managed by trainees from the Movement Sciences degree course.

Impact of 13valent vaccine for prevention of pneumococcal diseases in children and adults at risk: possible sceneries in Campania region

BACKGROUND Pneumonias are the most frequent infectious disease, characterized by a high prevalence especially among children and adults at risk. The socio-economic impact caused by Streptococcus pneumoniae is evaluated in terms of morbidity, death rate and hospitalizations. OBJECTIVE The aim of the study was to demonstrate the potential economic advantages by implementation of an active anti-pneumococcal 13-valent vaccine strategy in Campania region ( Southern Italy) in two different categories of subjects, children (aged 0-12), and adults (aged 50-79) at risk (hypertension, nephropathies, COPD and heart diseases) Methods. Vaccination costs were compared with costs necessary to treat avoidable diseases in presence and absence of a vaccination program. RESULTS Offering anti-pneumococcal 13-valent vaccine to the paediatric population was quantified as saving one million euros for Italian national health service in two years. In addition , offering anti-pneumococcal vaccine to adults at risk would generate a return of around 29 million euros. CONCLUSION In both cases, offering anti-pneumococcal 13-valent vaccine was proven to be a helpful political health strategy, not only in consideration of a reduction of cases, but also in view of the favourable economic impacts.

Effects of a community-based exercise and motivational intervention on physical fitness of subjects with type 2 diabetes

BACKGROUND This study aimed to analyze the effects of a long-term community-based combined exercise program consisting of aerobic, resistance, flexibility and agility/balance training associated with motivational interviewing on physical fitness, physiological parameters and Physical Activity (PA) levels in middle-aged and older patients with Type 2 Diabetes (T2D). METHODS Sixty-nine diabetic subjects (mean age 63 ± 5.2 y, 62.3% M) underwent a 9-month exercise program and 12 motivational group meetings focused on PA, while 90 diabetic controls (mean age 64 ± 6.4 y, 58% M) underwent usual PA recommendations. Changes in physical fitness measured by Senior Fitness Tests, BMI, HbA1c, waist circumference (WC) and habitual PA expressed in Metabolic Equivalent of Tasks (METs)-min/week were evaluated in each group through the International PA Questionnaire and compared between groups. RESULTS At the end of the intervention participants showed significant improvements in BMI (29.3 to 27.6 kg/m2, P < 0.03), HbA1c (6.5 to 6.1%, P < 0.01), WC (104.2 to 95.6 cm, P < 0.01) and all the physical fitness parameters (P < 0.01) but lower body flexibility (P = 0.82), while only upper body strength (P = 0.04) and agility (P ≤ 0.01) improved significantly in controls. Habitual PA increased in participants and controls (+67 and +19 METs-min/week, respectively, P ≤ 0.01). Changes in physical fitness and PA levels registered in the two groups differed significantly (P < 0.01), while improvements in BMI, HbA1c and WC did not (P = 0.40, P = 0.52, P = 0.05, respectively). CONCLUSIONS A long-term motivational exercise-based intervention may be more effective than PA recommendations only in improving physical fitness and PA levels in individuals with T2D and produce similar health improvements.

Effects of nutrition motivational intervention in patients affected by type 2 diabetes mellitus: a longitudinal study in Naples, South Italy

BackgroundType 2 diabetes (T2D) is associated with a prion diminished quality of life, especially due to the severe complications that it implicates. Changing dietary habits is an absolute priority, as well as implementing nutritional motivational programs. The aim of this study was to verify the effectiveness of a nutritional intervention in improving the health of patients affected by T2D.MethodsA total of 69 patients participated in a nine-months motivational program focused on the principles of the Mediterranean diet, the classes of nutrients, the distribution of the meals during the day and the dietary choices. During regular meetings, the patients were requested to fill out a questionnaire about their dietary habits and behaviours. Clinical and metabolic parameters were also analysed.ResultsAt the end of the intervention the number of people who declared that they ate five meals a day (p = 0.006) and preferred to have fruit for snack (p = 0.004) increased, while there was a reduction in the use of sweeteners and an elimination of the use of fructose (p = 0.05). The total daily consumption of kilocalories (kcal) had been reduced and the percentages of carbohydrates, proteins and lipids, after the intervention, follow the guidelines. In relation to this, a significant improvement (p < 0.05) was registered in systolic and diastolic pressure, BMI and waist circumference, as well as in glycaemic values (p = 0.018).ConclusionsA nutritional motivational intervention may be useful in improving dietary habits and health status of patients with T2D. We hope that a similar intervention will be applied in Campania and in other Italian regions.Trial registrationRegistration number is ISRCTN11067689; date of registration: 10/09/2018. Retrospectively registered.

Analyzing the Effects of Psychotherapy on Weight Loss after Laparoscopic Gastric Bypass or Laparoscopic Adjustable Gastric Banding in Patients with Borderline Personality Disorder: A Prospective Study

Background and Aims: Personality disorders are frequently associated with eating disorders in obese patients and may negatively affect weight loss and maintenance after bariatric surgery. This non-randomized study aimed to assess the effects of different psychotherapeutic interventions on weight loss in a sample of patients with borderline personality disorder who underwent laparoscopic gastric bypass or laparoscopic adjustable gastric banding. Materials and Methods: A total of 153 bariatric patients meeting borderline personality disorder criteria were chosen voluntarily and consecutively to undergo an interpersonal individual treatment (n = 50), a dialectical behavioral group treatment (n = 50), or treatment as usual (n = 53) for a year after surgery. Their body mass index was measured before and at the end of each treatment. Results and Conclusion: A total of 12 patients (7.8%) dropped out of the study. Significantly higher body mass index reductions were registered in both experimental groups (−14.2 and −9.4 kg/m2, respectively) compared with the treatment as usual group (−2.1 kg/m2; p < 0.01). Treated patients who underwent laparoscopic gastric bypass (total n = 94) showed better outcomes than those who underwent laparoscopic adjustable gastric banding (total n = 45), while no differences were observed in untreated patients. This study demonstrates the role of pre-operative psychological assessment and post-operative psychotherapeutic support in improving weight loss among bariatric patients with borderline personality disorder. A randomized controlled trial is needed to confirm these preliminary findings.