RESUMEN
In July-September 2012, one month earlier than in previous years, 13 confirmed human cases of West Nile virus infection were diagnosed in northern Italy, including five with neuroinvasive disease, three with West Nile fever, and five West Nile virus (WNV)-positive blood donors. In nine cases, the presence of the WNV lineage 1a Livenza strain, characterised in 2011, was ascertained. Symptomatic patients had prolonged viruria with high viral load.
Asunto(s)
Brotes de Enfermedades , ARN Viral/genética , Fiebre del Nilo Occidental/virología , Virus del Nilo Occidental/genética , Donantes de Sangre , Estudios de Seguimiento , Humanos , Italia/epidemiología , Vigilancia de la Población/métodos , Reacción en Cadena en Tiempo Real de la Polimerasa , Análisis de Secuencia , Carga Viral , Fiebre del Nilo Occidental/epidemiología , Fiebre del Nilo Occidental/genética , Virus del Nilo Occidental/aislamiento & purificaciónRESUMEN
During 2008-2009, several human cases of WNV disease caused by an endemic lineage 1a strain were reported in areas surrounding the Po river in north-eastern Italy. Since 2010, cases have been recorded in nearby northern areas, where, in 2011, both lineage 1a and 2 were detected. We describe here two new WNV complete genome sequences from human cases of WNV infection occurring in 2011 in the Veneto Region. Phylogenetic analysis showed that both genome sequences belonged to lineage 1a and were related to WNV strains of the Western Mediterranean subtype. The novel WNV genomes had high nucleotide and amino acid sequence divergence from each other and from the WNV strain circulating in Italy in 2008-2009. The presence of different WNV strains in a relatively small geographical area is a novel finding with unpredictable impact on human disease that requires further investigation.
Asunto(s)
Genoma Viral , ARN Viral/genética , Análisis de Secuencia de ADN , Fiebre del Nilo Occidental/virología , Virus del Nilo Occidental/genética , Variación Genética , Genotipo , Humanos , Italia , Datos de Secuencia Molecular , Filogenia , Virus del Nilo Occidental/clasificación , Virus del Nilo Occidental/aislamiento & purificaciónRESUMEN
We report here the first blood donation positive for West Nile virus (WNV) by nucleic acid amplification testing collected in north-eastern Italy in July 2012.Partial sequencing of the WNV RNA demonstrated identity with a WNV lineage 1a genome identified in the same area in 2011 and divergence from the strain responsible for the outbreak in northern Italy in 200809. These data indicate that WNV activity in northern Italy is occurring earlier than expected and that different WNV strains are circulating.
Asunto(s)
Donantes de Sangre , ARN Viral/genética , Fiebre del Nilo Occidental/virología , Virus del Nilo Occidental/genética , Enfermedades Endémicas , Humanos , Italia/epidemiología , Técnicas de Amplificación de Ácido Nucleico , Filogenia , Vigilancia de la Población , Análisis de Secuencia , Fiebre del Nilo Occidental/epidemiología , Fiebre del Nilo Occidental/genéticaRESUMEN
In 2010, for the third consecutive year, human cases of West Nile virus (WNV) infection, including three confirmed cases of neuroinvasive disease and three confirmed cases of West Nile fever, were identified in north-eastern Italy. While in 2008 and 2009 all human cases of WNV disease were recorded in the south of the Veneto region, cases of WNV disease in 2010 additionally occurred in two relatively small northern areas of Veneto, located outside those with WNV circulation in the previous years. WNV IgG antibody prevalence in blood donors resident in Veneto was estimated as ranging from 3.2 per 1,000 in areas not affected by cases of WNV disease to 33.3 per 1,000 in a highly affected area of the Rovigo province. No further autochthonous human cases of WNV disease were notified in Italy in 2010. The recurrence of human cases of WNV infection for the third consecutive year strongly suggests WNV has become endemic in north-eastern Italy.
Asunto(s)
Anticuerpos Antivirales/sangre , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Fiebre del Nilo Occidental/epidemiología , Virus del Nilo Occidental/aislamiento & purificación , Adulto , Anciano , Animales , Anticuerpos Antivirales/inmunología , Donantes de Sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunoglobulina G/inmunología , Inmunoglobulina M/inmunología , Italia/epidemiología , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Prevalencia , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Sensibilidad y Especificidad , Estudios Seroepidemiológicos , Fiebre del Nilo Occidental/diagnóstico , Fiebre del Nilo Occidental/virología , Virus del Nilo Occidental/inmunologíaRESUMEN
Following reports of West Nile neuroinvasive disease in the north-eastern area of Italy in 2009, all blood donations dating from the period between 1 August and 31 October 2009 in the Rovigo province of the Veneto region were routinely checked to exclude those with a positive nucleic acid test for West Nile virus (WNV). Only one of 5,726 blood donations was positive (17.5 per 100,000 donations; 95% confidence interval (CI): 0.497.3). In addition, a selection of 2,507 blood donations collected during the period from 20 July to 15 November 2009 were screened by ELISA for IgG and IgM antibodies against WNV. A positive result was received for 94 of them. The positive sera were further evaluated using immunofluorescence and plaque reduction neutralisation test (PRNT), in which only 17 sera were confirmed positive. This corresponds to a prevalence of 6.8 per 1,000 sera (95% CI: 4.010.9). In a case-control study that matched each of the 17 PRNT-positive sera with four negative sera with the same date of donation and same donation centre, we did not find a significant association with age and sex of the donor; donors who worked mainly outdoors were significantly more at risk to have a positive PRNT for WNV.
Asunto(s)
Anticuerpos Antivirales/sangre , Donantes de Sangre , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Fiebre del Nilo Occidental/epidemiología , Virus del Nilo Occidental/aislamiento & purificación , Adulto , Anciano , Anticuerpos Antivirales/inmunología , Ensayo de Inmunoadsorción Enzimática , Femenino , Técnica del Anticuerpo Fluorescente , Técnica de Placa Hemolítica , Humanos , Inmunoglobulina G/inmunología , Inmunoglobulina M/inmunología , Incidencia , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pruebas de Neutralización , Prevalencia , Estudios Retrospectivos , Sensibilidad y Especificidad , Estudios Seroepidemiológicos , Fiebre del Nilo Occidental/diagnóstico , Fiebre del Nilo Occidental/virología , Virus del Nilo Occidental/inmunologíaRESUMEN
In 2009, six new human cases of West Nile neuroinvasive disease (WNND) were identified in Veneto region, following the six cases already reported in 2008. A human West Nile virus (WNV) isolate was obtained for the first time from an asymptomatic blood donor. Whole genome sequence of the human WNV isolate showed close phylogenetic relatedness to the Italy-1998-WNV strain and to other WNV strains recently isolated in Europe, with the new acquisition of the NS3-Thr249Pro mutation, a trait associated with avian virulence, increased virus transmission, and the occurrence of outbreaks in humans.
Asunto(s)
Secuencia de Bases , Genoma , Virus del Nilo Occidental/genética , Virus del Nilo Occidental/aislamiento & purificación , Secuencia de Aminoácidos , Brotes de Enfermedades , Humanos , Italia , Datos de Secuencia Molecular , Filogenia , Fiebre del Nilo Occidental/epidemiologíaRESUMEN
A positive correlation between PCNA and the most important histoprognostic factors of cutaneous melanoma has been demonstrated. The aim of our work was to evaluate the efficacy of PCNA in predicting melanoma recurrence and to compare it with that of Breslow thickness. One-hundred and fifteen patients (75 women, 40 men; mean age 50 years) with primary cutaneous melanoma were retrieved. pTNM stages were as follows: stage I, 54 patients; stage II, 31 patients; stage III, 26 patients; and stage IV, four patients. The mean follow-up period was 55 months (range 2-260). Six patients developed lymph node metastases and 28 developed distant metastases; 27 patients died within 2-202 months from diagnosis. Tumour thickness was re-evaluated for each case. PCNA immunostaining was performed using the avidin-biotin complex method and the percentage of PCNA-positive tumour cells was indicated as the PCNA index. In order to evaluate and compare the PCNA index and Breslow thickness as predictors of recurrence, the receiver-operating characteristic (ROC) curve method, based on true-positive and false-positive rates was used. The PCNA index showed the highest true-positive rates and the lowest false-positive rates in the 5-30 interval. The PCNA index optimal cut-off is 20, characterized by 70% sensitivity and 80% specificity; Breslow thickness optimal cut-off is 3.5 mm, with 40% sensitivity and 90% specificity. Our results indicate that the PCNA index has a higher efficacy in predicting locoregional and distant recurrences in patients presenting primary cutaneous melanoma.
Asunto(s)
Melanoma/química , Melanoma/secundario , Recurrencia Local de Neoplasia/química , Antígeno Nuclear de Célula en Proliferación/análisis , Neoplasias Cutáneas/química , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Técnicas para Inmunoenzimas , Modelos Lineales , Masculino , Melanoma/patología , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Sensibilidad y Especificidad , Neoplasias Cutáneas/patologíaRESUMEN
The coding error rate of systems for medical record statistical cards (MRSCs) throughout health services is about 30%. A program using automatic coding has been developed at the Institute of Clinical Surgery II, Padua University Hospital, with a view to reducing this percentage. Out of an overall sample of 4776 MRSCs from all departments of the hospital, 54 were automatically coded at our institute. Categories of discrepancy between the discharge diagnosis codes of the 4722 manually coded MRSCs and the other 54 MRSCs were classified as follows: types I-III, diagnosis assigned to an erroneous under-class, class or heading (ICD-9) respectively; type IV, incorrect diagnosis formulation precluding code assignment; type V, two or more discrepancies on MRSC; and type VI, secondary diagnosis not coded. Discrepancy rates were as follows: 22.3% and 0.0% for type I; 21.3% and 0.0% for type II; 17.6% and 0.0% for type III; 1.9% and 0.0% for type IV; 5.8% and 0.0% for type V; 31% and 1.9% for type VI. Code discrepancy rates for surgical procedures, which were also compared, ranged from 7.0 to 12.5% for manual coding, while no discrepancy was observed in automatically-coded MRSCs. The results clearly demonstrate the utility of the system reported on, and it is suggested that it should be used in a modified form in other hospital departments.