Comparison between thrombotic risk scores in essential thrombocythemia and survival implications

The conventional thrombotic risk stratification in essential thrombocythemia (ET) distinguishes patients in two risk groups based on previous thrombosis and age (< or >60). The IPSET-thrombosis takes into account four risk factors: age greater than 60 years and the presence of CV risk factors, thrombosis history and JAK2 V617F presence. The revised IPSET-thrombosis uses three adverse variables to delineate four risk categories: age greater than 60, thrombosis history, and JAK2 V617F presence. We compared different risk models in the estimation of thrombotic risk in 191 patients with ET and the role of specific driver mutations affecting overall survival, according to thrombotic risk. We also evaluated the mutational status of patients showing history of thrombosis or cardiovascular events versus patients who did not. Finally, we verified whether the thrombotic risk had a significant impact on survival in our ET patients. The data analysis has been performed through the conventional statistics and overall survival estimated by using the Kaplan-Meyer method. Interestingly, either using the traditional system for thrombotic risk or the IPSET-t prognostic score or the current stratification for the thrombotic risk, high-risk patients are always highly represented. This evidence is of note, being the high-risk category indicated for cytoreduction, affecting quality of life, despite the good overall prognosis of patients with ET diagnosis in general. The analysis of overall survival in our patients, according to different models for thrombotic risk, highlighted the poor prognosis of high-risk patients compared with those with a lower thrombotic risk, in particular when using traditional stratification and current stratification. In conclusion, the occurrence of thrombotic or cardiovascular events represents one of the most severe complications at diagnosis or during follow-up of ET despite current recommendations, having a significant impact on morbidity and survival.

Prevalence of sexually transmitted infections and enteric protozoa among homosexual men in western Sicily (south Italy)

INTRODUCTION

In recent years an increase in the number of sexually transmitted infections (STIs) in men who have sex with men (MSM) has been reported in different industrialised countries. Because few epidemiological data on the STls/MSM population in Sicily are available, a survey was conducted to assess the prevalence of STls/enteric protozoa and risky sexual behaviours among MSM in western Sicily.

METHODS

In 2010, 74 MSM with median age of 30 years old, were recruited via networks. All participants to the study were interviewed by anonymous self-administered questionnaire in order to collect social/demographic information, clinic data and STI-related risky sexual behaviours. After completing the questionnaire, blood samples were collected to determine HIV, HCV, HHV8 and Treponema pallidum antibodies; presence of Giardia duodenalis and Cryptosporidium parvum was also investigated in faecal samples by immunofluorescence assay.

RESULTS

HIV, HHV8, T. pallidum and Giardia prevalence were 8.1%, 16.2%, 21.6% and 16.4% respectively; all patients were negative for HCV and Cryptosporidium infections. The median values of sexual anal intercourse and oral sex per week were 2 and 1, respectively. 7% of participants always had unprotected anal sex, 50.7% sometimes used condom during sexual anal intercourse and 42.3% always had protected anal sex. All MSM-HIV+ and 7 (43.7%) syphilis seropositives were unaware of their own infection.

DISCUSSION

MSM in western Sicily are a high risk group for important STIs. It seems necessary that continuous interventions for preventing HIV/AIDS and other STls and for improving the level of knowledge of symptoms are needed.

[Knowledge, attitude, and practice of the use of ready-to-eat vegetables among potential consumers of Palermo (Italy)]

The knowledge, attitude, and practice toward the use of ready-to-eat vegetables were evaluated in a sample of 701 (388 women and 313 men) potential consumers in Palermo, by answering to an anonymous questionnaire handed out. Food safety perceptions and behaviors were analysed; in general, interviewed consumers who perceived higher risks exhibited safer food behaviors. There weren't considerable differences in the use of these salads between two sexes; 81.4% of respondents uses these products to save a lot of time, particularly the graduates attach importance to saving in time (p = 0.001), and only 34.4% is worrying about high price. Statistical analysis showed a significant correlation between better food safety knowledge and female sex; for example, compared with women, men reported to buy ready-to-eat salads on sale at room temperature and at temperature of refrigerator without distinction (p = 0.015). This study confirms the IV range salads meet modern consumer's requirements and also suggests the need of food safety educational strategies for targeted groups.

[Occurrence of Giardia cysts and Cryptosporidium oocysts in swimming pools in the province of Palermo, Italy]

21 samples of waters of 7 swimming pools in the province of Palermo were investigated for the presence of Giardia cysts and Cryptosporidium oocysts. Some chemio-physical parameters (chlorine, temperature, turbidity and pH) were also evaluated as well as the presence of bacterial indicators of faecal (total coliforms, Escherichia coli and enterococci), mucocutaneous and environmental (Staphylococcus aureus and Pseudomonas aeruginosa) contamination. All samples were negative for bacterial indicators of faecal contamination; 3 were positive for the presence of coagulase-negative staphylococci, 1 was positive for Alcaligenes spp. and 2 for Pseudomonas aeruginosa. 8 samples proved to be positive for Giardia and 6 also for Cryptosporidium. All but one of them were coming from waters of 2 swimming pools of the same recreational center. In all samples the concentration of Giardia was substantially higher than that of Cryptosporidium. This study shows that the disinfection and filtering plants are not always suitable to ensure a good level of the quality of the waters of swimming pools and suggests that should be necessary to check them also for the presence of protozoa like Giardia and Cryptosporidium, which may be responsible for gastroenteritis.

[Development of a technique for recovering Giardia cysts and Cryptosporidium oocysts from fresh vegetables]

Techniques described for recovering Giardia and Cryptosporidium (oo)cysts from fruit and vegetables are generally inadequate and present variable recovery efficience and elevated costs. The aim of our study was to evaluate the recovery efficiency of a simple and economic technique to apply either to berry vegetables, like tomatoes and peppers, or to large leave vegetables, like lettuce and chicory. The method include contamination and further elution of the vegetables. Then sedimentation of (oo)cysts by centrifugation of the eluate of vegetables and their visualization by means of direct immunofluorescence. The higher recovery values for both protozoa were obtained in large leave vegetables with mean data above 70% for Giardia and 76% for Cryptosporidium, whereas the values observed in the berry vegetables were above 43% for Giardia and above 37% for Cryptosporidium on average.

[Occurrence of Giardia and Cryptosporidium in wastewater, surface water and ground water samples in Palermo (Sicily)]

This paper reports the investigation carried out on the occurrence of Cryptosporidium and Giardia (oo)cysts in water samples of two municipal treatment plants, and in surface water and ground water wells of the province of Palermo. The wastewater samples taken before and after treatment process were assayed over the course of one year Giardia cysts were detected in all samples throught the year at higher concentration levels than Cryptosporidium oocysts, with a peak observed in spring. The overall removal efficiency of (oo)cysts in the treatment plants was about of 90%. Their presence were also searched in surface waters (three artificial lakes and one river); (oo)cysts were detected in one lake at very low concentration; on the contrary, both parasites were found at high concentration levels in all the samples collected throught one year from the water of the river. The pattern of occurrence of both parasites appears temporally related to the level of rainfall trend. Cryptosporidium and Giardia were also found in ground water wells; their presence occurred only in waters taken from wells at a depth lower than 31 meters with concomitant presence of faecal bacteria. These results may provide further insight into the possible source of Cryptosporidium and Giardia in natural environmental and stress the potential risk associated with the use of waters for recreational and agricultural purposes.