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OBJECTIVE--To clarify the pathogenesis of diabetes associated with mutations of the hemochromatosis (HFE) gene, 17 carriers, 9 normal glucose tolerant (NGT) and 8 diabetic, were evaluated in an interventional trial. [...]

Abstract: We present a 70-year-old woman with pre-B acute lymphoblastic leukemia in whom serial imaging studies showed the development of multiple vertebral collapse, and communicating superior and inferior Schmorl’s nodes creating a longitudinal channel (”tunneling” Schmorl’s nodes) through the anterior aspect of T12 to L3 vertebral bodies of her osteoporotic thoracolumbar spine. This was observed after achieving complete remission of the disease and during maintenance therapy. The finding is felt to be secondary to iatrogenic exacerbation of osteoporosis.

ABSTRACTBlood samples were drawn daily from 72 patients who had hematological malignancies, neutropenia, and fever and who had failed to respond to broad-spectrum antibiotics. Each sample was used for conventional fungal blood cultures and for detection and identification of CandidaDNA by a PCR method with subsequent restriction enzyme analysis (REA) recently developed in our laboratory. The PCR method was able to detect five CFU of Candidaspp. per ml of blood, and subsequent REA of the amplicons allowed the identification of the Candidaspecies most commonly implicated in cases of candidiasis. Thirty-one patients were PCR-REA positive, and four of these patients were also culture positive. The ultimate diagnosis for 13 of these patients and 1 patient who was PCR-REA negative was disseminated candidiasis (confirmed by clinical data, multiple cultures, histology, autopsy, and/or ultrasonographic evidence of hepatosplenic candidiasis). The molecular method is significantly more sensitive than conventional fungal blood cultures and has a high negative predictive value (97.5%) for the development of disseminated candidiasis in neutropenic patients.

Brilli: Pharmanutra S.p.A.: Consultancy. Pera: Pharmanutra S.p.A.: Employment. Tarantino: Pharmanutra S.p.A.: Employment.

Introduction: Iron deficiency anemia (IDA) represents a major public health problem. Oral administration has been recognized as the most convenient and safest route for iron treatment. However, most of the traditional iron supplements encounter several obstacles when orally administrated due to their poor solubility and bioavailability. The absorption of commonly used ferrous iron salts is low as the soluble form ferrous iron is easily oxidized to a poorly soluble one ferric iron and also because the absorption of ferrous iron is mediated by the divalent metal transporter 1. In order to overcome gastrointestinal barriers, there is a need for new absorption and protective enhancers acting as carriers and able to promote iron absorption. Microfold cells (M cells) of the Peyer's patches (PP) are found in the gut and mucosa-associated lymphoid tissues. These cells are known for the transport of microbes and particles across the epithelial cell layer from the gut lumen to the lamina propria where interactions with immune cells take place. Previous studies demonstrate that M cells are a common pathway for oral nanoparticles absorption. However physicochemical properties of particles critically influence the efficacy of oral delivery to the lymphatic system. Recently, we have developed a new oral Iron formulation named Sucrosomial® Iron. This oral formulation is an innovative preparation of ferric pyrophosphate, covered by a phospholipids plus sucrester matrix, with high bioavailability, tolerability and gastro-resistance properties that shows an improvement in Hb levels similarly to intravenous iron and without any gastrointestinal side effects; thus, Sucrosomial®Iron can be used as an alternative to common iron salts to improve iron supplementation effectiveness.

No relevant conflicts of interest to declare.

Tarantino: Pharmanutra s.p.a.: Employment. Brilli:Pharmanutra s.p.a.: Employment.

Tarantino: Pharmanutra s.p.a.: Employment. Brilli:Pharmanutra s.p.a.: Employment.

No relevant conflicts of interest to declare.

No relevant conflicts of interest to declare.

Introduction Lactobacilli are currently proposed as probiotic agents in several dietary products. In blood cultures, they are usually considered as contaminants, but in recent years they have been recognized as causal infectious agents of endocarditis, urinary tract infections, meningitis, intra-abdominal infections and bacteraemia.Case presentation We report a case of Lactobacillus casei bacteraemia in a 66-year-old immunocompetent man with a history of fever of unknown origin. Leuconostoc bacteraemia was demonstrated by blood culture, but a later polymerase chain reaction analysis with sequencing of 16S ribosomal RNA identified Lactobacillus casei and a successful antibiotic therapy was performed.Conclusion Bacteraemia caused by probiotic organisms is rare but underestimated, since they are normally regarded as contaminants and their role as primary invaders is not always easily established. Although the consumption of probiotic products cannot be considered a risk factor in the development of diseases caused by usually non-pathogenic bacteria, specific individual clinical histories should be taken into account. This report should alert both clinicians and microbiologists to the possibility of unusual pathogens causing serious illnesses and to the use of 16S ribosomal RNA sequencing for molecular identification as a powerful tool in confirming the diagnosis of infrequent pathogens.

The antithrombotic strategy of Polycythemia Vera is usually modulated according to age and thrombotic history but there is a clear need for a more accurate stratification of the vascular risk in the individual patient. The present study exploited the large database collected within the cohort study of European Collaboration on Low-dose Aspirin in Polycythemia Vera (ECLAP) to investigate how haematological variables as well as cardiovascular risk factors may be associated with the thrombotic risk. We used prospectively ascertained information among 1,638 polycythemic patients recruited in the ECLAP observational study and followed for a maximum of 5 years (mean [SD] 2.7 [1.3] years). Information on clinical history, treatment, hematological parameters, and cardiovascular risk factor were assessed at baseline and updated at 1, 2, 3, 4, and 5 years. Multivariable, time-dependent analyses were fitted to assess the association between white blood cell count and thrombotic events during follow-up. Over this period there were 205 thromboses in 169 patients. The time-dependent analysis adjusted for potential confounders confirmed that age and previous thrombotic event are independent predictive factors. As compared to patients with white blood cell count below 10,000x106/L, those with white blood cell count above 15,000x106/L showed a significant increase of the risk of thrombotic events (Hazard Ratio 1.71; 95% confidence interval 1.10 to 2.65; P=0.0171) mainly deriving from an increased risk of myocardial infarction (Hazard Ratio 2.84; 95% confidence interval 1.25 to 6.46; P=0.0127). Patients with white blood cell count above 15,000x106/L had an increased, though statistically non significant, risk of venous thromboembolism (Hazard Ratio 1.81; 95% confidence interval 0.84 to 3.89; P=0.1272). Subjects with hypertension had a mild, non significant increase of the risk of arterial thrombosis while smoke was significantly associated with an increased risk of arterial thrombotic events (Hazard Ratio 1.90; 95% confidence interval 1.15 to 3.14; P=0.0120) and was non significantly associated with the risk of of peripheral artery disease (Hazard Ratio 2.86; 95% confidence interval 0.92 to 8.86; P=0.0692) and of stroke/TIA (Hazard Ratio 1.89; 95% confidence interval 0.89 to 4.01; P=0.0978). Hypercholesterolemia and diabetes had a limited prevalence among our patients and could not be evaluated as to their impact on the vascular risk. The association of thrombotic events with leukocytosis provided novel information on epidemiology as well as on possible pathogenetic mechanisms of thrombosis in Polycythemia vera. Leukocytosis has to be considered for risk stratification and for choosing and targeting treatment options particularly in patients with previous myocardial infarction or venous thromboembolism. Finally, the high prevalence of smoke and its impact on thrombotic risk call for an effective lifestyle intervention in polycythemic patients.