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E-health technologies improve healthcare quality and disease management. The aim of this study was to develop a ketogenic diet management app as well as a website about this dietary treatment and to evaluate the benefits of giving caregivers access to various web materials designed for paediatric patients with refractory epilepsy. Forty families participated in the questionnaire survey, from January 2016 to March 2016. All caregivers were exposed to paper-based materials about the ketogenic diet, whereas only 22 received the app, called KetApp, and videos produced by dieticians. Caregivers with free access to web materials were more satisfied than the others with the informative material provided by the centre ( p ≤ 0.001, Mann-Whitney test). Indeed, they showed a better attitude towards treatment, and they became more aware of dietary management in comparison to the control group ( p ≤ 0.001). Moreover, caregivers provided with web materials were stimulated to pursue the treatment ( p = 0.002) and to introduce it to their children and other people ( p = 0.001). Additionally, caregivers supplied with web materials were more willing to help other families in choosing the ketogenic diet ( p = 0.004). Overall, these findings indicate that web materials are beneficial for caregivers of paediatric patients with refractory epilepsy in our centres. Thus, the use of e-health applications could be a promising tool in the daily aspects of ketogenic diet management, and it is especially of value in the attempt to start or maintain the diet during the ongoing COVID-19 pandemic crisis.

Purpose: In the management of bariatric surgery follow-up, a multidisciplinary approach allows to evaluate the weight loss maintenance and the dietary and lifestyle changes adherence. The main aim of this study is to create and to validate a questionnaire (eating behavior after bariatric surgery (EBBS)) to objectivize the compliance to dietary/lifestyle suggestions after bariatric surgery., Materials and Methods: An observational retrospective monocentric clinical trial was carried out at the Bariatric Surgery Unit of Modena, Italy. All weight-related data of bariatric surgery patients collected during the multidisciplinary post-surgical path were recorded. EBBS questionnaire and three validated psychological tests were administered. EBBS includes 11 questions concerning food (domain A), drinks (B), behaviors (C), and lifestyle (S). All data analyzed in the study were collected during the same visit., Results: In 41 enrolled patients (52.2 + 11.9 years), the total weight loss after surgery was 44.87 + 18.37 kg (- 35.40 + 11.60%), with a weight loss maintenance of 86.92 + 14.30%. The EBBS questionnaire showed a good internal validity (Cronbach's alpha 0.743, Hotelling's T-square test p < 0.001). The S domain was directly related with the percentage of weight loss maintained (p = 0.048), suggesting that the frequent physical activity and the periodic weight self-check are the most predictive behaviors to obtain weight control. None of the psychological questionnaires appeared related to the weight trend., Conclusions: We validated for the first time a 11-item self-filling questionnaire allowing to quantify the adaption to dietary/lifestyle suggestions provided after bariatric surgery. EBBS questionnaire could be a useful tool both in clinical and research setting to monitor the patient's adherence to post-surgical indications and to identify predictive factors for bariatric surgery efficacy.

Pseudomonas aeruginosa is a frequent causative agent of healthcare-associated diseases, but recently, other members of the Pseudomonas genus have been recognized to cause human colonization and infection. Since the aquatic environment could be an important source of contamination, we studied the drug resistance and virulence profiles in Pseudomonas species isolated from healthcare water systems. 17 Pseudomonas spp. out of 57 were randomly selected and their drug resistance and virulence profiles were later evaluated. Based on the positivity to the tests, the adhesion capability and biofilm formation on polystyrene and glass surfaces were studied in 6 strains, each belonging to different species. Six Pseudomonas strains (35%) were α-hemolytic, nine (53%) showed a positivity to the gelatinase test, and P. acidovorans 2R only was capable to degrade DNA. All Pseudomonas strains presented urease activity and the production of siderophores was widely observed (64,7%). Most of the strains showed one of the three types of motilities, 15 Pseudomonas (88.23%) resulted bacteriocin producers and all strains were resistant to one or more antibiotics. Lastly, among the six selected strains, P. aeruginosa 98.5 and P. fluorescens 97.4 were the best biofilm producers. Our study has highlighted how the majority of isolates shows biological characteristics that contribute to the pathogenicity of Pseudomonas. These features emphasize the virulence potentiality of other members of the Pseudomonas genus besides Pseudomonas aeruginosa, making them potentially pathogenic, especially against immunocompromised individuals.

We investigated the occurrence of extended-spectrum β-lactamase (ESBL), AmpC, and carbapenemase-producing Gram-negative bacteria isolated from 160 samples of fresh vegetables (n = 80) and ready-to-eat (RTE) prepacked salads (n = 80). Phenotypic and genotypic analyses were carried out on the isolates in terms of the species present and relative resistance. Resistance to β-lactam antibiotics was found in only 44 (24 from fresh vegetables and 20 from RTE salads) of a total of 312 Gram-negative strains (14.1%). The prevalence of ESBL-producing strains from fresh vegetables was 83.3% (20/24) and 16.7% (4/24) for AmpC. Among the 20 bacterial isolates from RTE salads, 80% (16/20) were identified as ESBL-producing strains and the remaining 20% (4/20) as MBL-producing strains. PCR and sequencing confirmed the presence of bla SHV-12 , bla CTX-M-1 , bla CTX-M-15, bla RHAN -1 , bla ACC-1 , bla DHA-1 , bla VIM-1 . Seven different replicons were identified, where IncHI1, FIA, and I1 were the most representative types; when compared with the Inc types, isolates from fresh vegetables and RTE salads were similar. The location of genes on a conjugative plasmid was confirmed by positive results obtained with conjugation assays. Our study has demonstrated the occurrence and distribution of ESBL/AmpC and MBL strains in fresh vegetables and RTE salads in Italy and possible public health risks associated with consumption of these fresh products.IMP-1 . Seven different replicons were identified, where IncHI1, FIA, and I1 were the most representative types; when compared with the Inc types, isolates from fresh vegetables and RTE salads were similar. The location of genes on a conjugative plasmid was confirmed by positive results obtained with conjugation assays. Our study has demonstrated the occurrence and distribution of ESBL/AmpC and MBL strains in fresh vegetables and RTE salads in Italy and possible public health risks associated with consumption of these fresh products.

The aim of this study was to assess the production of extended spectrum beta-lactamases (ESBL) in 56 strains of Enterobacteriaceae, obtained from 100 rectal swabs of farm animals, and to evaluate the horizontal transfer ca- pacity of the genetic determinants of resistance. The ESBL-positive strains were confirmed by phenotypic testing, confirmed by PCR and DNA sequence analysis. The localization of beta-lactamase genes was established by conju- gation experiments. Of the 56 analyzed strains, 20 (36%) resulted positive for ESBL production by the double-disk synergy test, and belonged to Escherichia coli 15 (75%) and Klebsiella ozaenae 5 (25%) species. Molecular analysis showed that all ESBL-producing isolates possessed genes encoding for TEM-type enzymes and/or CTX-M. The conjugation assays yielded positive results, thus denoting a plasmidic localization of the genes. This study high- lights the high percentage of ESBL-positive Enterobacteriaceae and the mobility of the responsible genes. Gene mo- bility implies highly negative consequences in terms of drug therapy because of the spread of antibiotic resistance.

Considering the limited knowledge about the biological characters in enterococci isolated from surface waters, we investigated antibiotic and heavy-metal resistance, bacteriocin production, and some important virulence traits of 165 enterococci collected in water samples from Monte Cotugno Lake, the largest artificial basin built with earth in Europe. The species distribution of isolates was as follows: Enterococcus faecium (80%), Enterococcus faecalis (12.7%), Enterococcus casseliflavus (3%), Enterococcus mundtii (1.8%), Enterococcus hirae (1.8%), Enterococcus durans (0.6%). All enterococci showed heavy metal resistance toward Cu, Ni, Pb and Zn, were susceptible to Ag and Hg, and at the same time exhibited in large percentage (83.7%) resistance to one or more of the antibiotics tested. Relatively to virulence factor genes, 50.9% enterococci were positive for gelatinase (gelE), 10.9% for aggregation substance (agg), 12.7% and 66.6% for the cell wall adhesins (efaAfs and efaAfm), respectively. No amplicons were detected after PCR for cytolysin production (cylA, cylB and cylM) and enterococcal surface protein (esp) genes. Bacteriocin production was found in most of the isolates. Given that the waters of the Monte Cotugno Lake are used for different purposes, among which farming and recreational activities, they can contribute to spread enterococci endowed with virulence factors, and antibiotics and heavy metals resistance to humans.

Three Legionella pneumophila strains isolated from water samples and belonging to serogroups (sgs) 1, 6 and 9 were analysed for their capacity to colonise an experimental model simulating a domestic hot water distribution system. Ecological factors that could influence the persistence of the sgs such as intracellular life within protozoan hosts and bacterial interference by the production of antagonistic compounds were also studied. Viable counts of L. pneumophila increased both in the planktonic and in the sessile phases. Sg 6 showed a marked prevalence during the whole experiment and exhibited the highest host infection efficiency. Sg 1 was significantly less represented, but showed the highest capacity to reproduce in the protozoan hosts. Sg 9 was poorly represented and less adapted to intracellular life. Among the 14 bacteria constantly isolated in the system, five (35.7%) produced antagonistic substances against Legionella, with differences according to the bacterial strain and L. pneumophila sgs.

Objective: To investigate the influence of weight loss expectations (expected 1-year BMI loss, dream and maximum acceptable BMI) on attrition in obese patients seeking treatment., Research Methods and Procedures: Obese subjects (1,785; 1,393 women; median age, 46 years; median BMI, 36.7 kg/m(2)) seeking treatment in 23 medical Italian centers were evaluated. Baseline diet and weight history, weight loss expectations, and primary motivation for seeking treatment (health or improving appearance) were systematically recorded. Psychiatric distress, binge eating, and body image dissatisfaction were tested at baseline by self-administered questionnaires (Symptom Check List-90, Binge Eating Scale, and Body Uneasiness Test). Attrition and BMI change at 12 months were prospectively recorded., Results: At 12 months, 923 of 1,785 patients (51.7%) had discontinued treatment. Compared with continuers, drop-outs had a significantly lower age, a lower age at first dieting, lower dream BMI, a higher expected 1-year BMI loss, and a higher weight phobia. At logistic regression analysis, the strongest predictors of attrition at 12 months were lower age and higher expected 1-year BMI loss. The risk of drop-out increased systematically for unit increase in expected BMI loss at 12 months (hazard ratio, 1.12; 95% confidence interval, 1.04 to 1.20; p = 0.0018). The risk was particularly elevated in the first 6 months., Discussion: Baseline weight loss expectations are independent cognitive predictors of attrition in obese patients entering a weight-losing program; the higher the expectations, the higher attrition at 12 months. Unrealistic weight goals should be tackled at the very beginning of treatment.

Five penicillinase producing Neisseria gonorrhoeae (PPNG) were isolated from urethral specimens of men admitted to the "Santa Chiara" Hospital (Trento, Italy). All strains proved to be resistant to penicillin and ampicillin, and sensitive to cefuroxime, erythromycin, tetracycline, spectinomycin, nalidixic acid and ciprofloxacin. PPNG plasmid profiles showed that four of the isolates carried the 3.2 MDa "Africa" plasmid and one the 4.5 MDa "Asia" plasmid, the two well-known phenotypes reported in the USA and Europe as well as in Asian and African countries. Membrane matings were performed using N. gonorrhoeae carrying the 24.5 MDa conjugative plasmid as donors and E. coli K12 J 53 as recipient. The transfer of beta-lactamic antibiotic resistance was supported by the presence of 4.5 or 3.2 MDa plasmid bands and by beta-lactamase production in the transconjugants. Restriction analysis of Asian and African plasmids is reported.

Background and Aim: The capacity of the results of clinical studies to lead to changes in clinical practice is controversial. The treatment of elderly patients with acute myocardial infarction (AMI) represents an increasingly important challenge for the physician. The decreasing mortality rate for AMI in the general population is countered by an increasingly high mortality rate among the elderly. The aim of this prospective study was to evaluate the impact of the results of clinical studies on the treatment of AMI in community hospitals, and to highlight any differences in treatment and prognosis depending on age., Materials and Methods: 123 patients with AMI were divided into two groups: (1) young patients (61.2%) aged under 75 (76 patients of whom 64 were male, with a mean age of 61.08 +/- 9.63) and (2) elderly patients (38.8%) aged over 75 (47 patients of whom 26 were male, with a mean age of 81.77 +/- 3.94). All patients were monitored for at least 12 months after discharge., Results: The percentage administration of fibrinolytics (60.5%), aspirin (80.3%), beta-blockers (oral 40.8%; i.v. 32.9%) and anticoagulants (97.4%) showed that young patients were treated according to the indications reported in the literature. Thrombolysis was more frequently performed in young patients than in the aged (60.5% vs 10.6%; p = 0.0001). Multiple logistic regression analysis showed that age, Killip's class and time at hospitalization were variables predicting the exclusion from fibrinolysis. During hospitalization the elderly group received oral beta-blockers less frequently (8.5% vs 40.8%; p = 0.0001); on discharge, they less frequently received ACE-inhibitors (14.9% vs 46.1%; p = 0.0004), aspirin (48.9% vs 77.6%; p = 0.001), beta-blockers (12.8% vs 44.7%; p = 0.0002). The elderly group revealed a higher mortality rate both during hospitalization (19.1% vs 3.9%; p = 0.01) and follow-up (44.7% vs 11.0%; p = 0.0001). Multivariate analysis showed a direct correlation between ventricular arrhythmia and Killip's class and hospital mortality, whereas smoking and time at hospitalization were inversely correlated. Mortality during follow-up was directly associated with Killip's class and inversely to the use of ACE-inhibitors during hospitalization, and beta-blockers and diuretics on discharge. Kaplan-Meier analysis did not show any differences in the survival rate of the two groups, but the first year after AMI was particularly critical for elderly patients among whom 40% of all deaths were recorded., Conclusions: This study confirms the application in clinical practice of the results of clinical studies also in community hospitals, and shows that elderly AMI patients are high-risk patients. The high mortality in the latter group is correlated to the fact that they are less eligible to undergo fibrinolytic therapy and have a lower probability of receiving drugs of proven efficacy as a means of increasing survival after AMI. Further clinical studies are required to reduce mortality after AMI in a population that is increasingly widely represented in community hospitals.

Italian reports of PPNG strains are rare. In this paper we report the plasmidial characteristics of two strains: one harbouring 3.2 and 2.6 Mdal plasmids and the other 24.5, 4.5 and 2.6 Mdal plasmids. Restriction analysis was carried out on plasmids transferred to E. coli by transformation for "Africa" and conjugation for "Asia" plasmid.

The antibiotic-resistance of 450 strains of Salmonella isolated by the Microbiology Unit of the hospital of Modena during the years 1975-1977 was examined. During the study, the following antibiotics were assayed: ampicillin, kanamycine, tetracycline, chloramphenicol, streptomycin, sulfonamides, trimethoprim, tobramycin, gentamicin and nalidixic acid. The transfer capacity of antibiotic-resistance was measured by the double conjugation of E. coli K-12. During the period studied, a remarkable reduction was noted in those strains with multiple resistance (3 or more elements) decreasing from 72.9% in 1975 to 23.5% in 1977. These phenomena are due to the decrease of the serum-type wien during the years under study. Antibiotic-resistance demonstrated itself most frequently to streptomycin and tetracycline; and chloramphenicol-resistance showed the highest transfer capacity (97.2%).