Cattolica Del Sacro Cuore Research Articles

Global health challenges: Are future physicians prepared? The results of a 4 years training experience

Abstract Background Current health challenges are highlighting as Global Health (GH) is a discipline of growing importance for future physicians. Although its training is globally recommended, it has not universally entered the curricula of degree courses in Medicine and Surgery. A cycle of 6 seminars in global health has been promoted by researchers and public health residents of the Center for Research and Studies in GH of the Università Cattolica del Sacro Cuore (UCSC) in Rome, and offered for 4 consecutive years to medical students attending the UCSC. Objectives and Methods Main goal was increasing students knowledge and awareness in global health issues exploring their needs and perceptions about the impact of the topic on their future career. Two-hours frontal lessons held by experts and practical sessions (PBL) facilitated by promoters were planned on topics as determinants and inequalities in health, UHC, fragile and vulnerable population as migrants and victims of violence, SDGs, AIDS and emerging infectious diseases,international cooperation, maternal-child health. A pre-course, single event and post-course questionnaire was administered to participants. Results A mean of 48 students (± 15.7SD), 66.7% females, attending mainly the second(40.4%) and the third year (39%), joined each event. The analysis of the pre-course questionnaire has highlighted students' interest in healthcare inequalities, pandemics, migration, health in developing countries, healthcare systems. At the end, 92% of participants has considered the course interesting, 87% stated that the topic should be part of the degree course and 78% that it will influence their career. The methodology was considered adequate in 94% of cases underlining its strong incentive to work in team. Conclusions The strong interest of medical students in acquiring skills in global health seems to firmly encourage its inclusion and strengthening in study plans to prepare them properly to face the future challenges in health. Key messages Medical students consider the global health training relevant for their career encouraging its inclusion in the Medicine and Surgery curriculum. Practical sessions and team work could be useful tools to adequately train the future health workforce.

Spreading the culture of Engagement: experiences and perspectives

This article describes the fruitful collaboration between the Integrated Care Unit of the Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and the EngageMinds HUB research Center of the Università Cattolica del Sacro Cuore in the area of patient Engagement. Since then, thanks to this partnership, many training activities have been carried out, allowing healthcare professionals belonging to ASUGI to get trained about patient Engagement measurement and promotion (with particular reference to the Patient Health Engagement Model developed by Graffigna et al., 2015) (the PHE-Model®) in various settings, territory continuity programmes, as well as in some local services. The assessment of the process carried out has allowed to identify and promote initiatives aimed at improving the implementation processes of the PHE-Model®.

A co-constructed implementation path of active involvement practices in a context of integrated care: the experience of a participatory research with the ASUGI of Trieste

Introduction: In this article we can find the report of the main phases of the collaboration between ASUGI and the Università Cattolica del Sacro Cuore of Milan from 2015 to today.
 Methods: During these years, a path of activation and implementation of engagement practices within ASUGI has been developed, from basic training on the tools for monitoring and supporting engagement to the selection of a group of operators involved in a participatory path as “trainers to trainers”, up to the grafting of engagement practices within the individual patient education paths in the different sectors of ASUGI.
 Results and Conclusions: This contribution is an exemplifying scenario that can be useful for other health structures that want to undertake a similar path.

Place4Carers: a mixed-method study protocol for engaging family caregivers in meaningful actions for successful ageing in place

IntroductionEngaging family caregivers could be a critical asset to make the ‘ageing-in-place’ imperative a reality. This is particularly evident in rural and remote areas, where caregivers can fill the gaps...

Sarilumab Use in Severe SARS-CoV-2 Pneumonia

Background: Interleukin-6 signal blockade showed preliminary beneficial effects in treating aberrant host inflammatory response against SARS-CoV-2 leading to severe respiratory distress. Herein we describe the effect of off-label intravenous use of Sarilumab in patients with severe SARS-CoV-2-related pneumonia. Methods: 53 patients with SARS-CoV-2 severe pneumonia were treated with intravenous Sarilumab and pulmonary function improvement or Intensive Care Unit (ICU) admission rate in medical wards setting and live discharge rate in ICU treated patients and safety profile were recorded. Each patient received Sarilumab 400 mg intravenously on day 1, with eventual additional infusion based on clinical judgement, and was followed for at least 14 days, unless previously discharged or dead. Findings: Of the 53 SARS-CoV-2 pos patients receiving Sarilumab, 39(73·6%) were treated in medical wards [66·7% with a single infusion; median PaO 2 /FiO 2 :146(IQR:120-212)] while 14(26·4%) in ICU [92·6% with a second infusion; median PaO 2 /FiO 2 :112(IQR:100-141.5)]. Within the medical wards, 7(17·9%) required ICU admission, 4 of whom were re-admitted to the ward within 5-8 days. At 19 days median follow-up, 89·7% of medical inpatients significantly improved (46·1% after 24 hours, 61·5% after 3 days), 70·6% were discharged from the hospital and 85·7% no longer needed oxygen therapy. Within patients receiving Sarilumab in ICU, 64·2% were discharged from ICU to the ward and 35·8% were still alive at the last follow-up. Overall mortality rate was 5·7% after Sarilumab administration: 1(2·5%) patient died in the Medical Ward whilst 2(14·2%) patients died in ICU, respectively. Interpretation: IL-6R inhibition appears to be a potential treatment strategy for severe SARS-CoV-2 pneumonia and intravenous Sarilumab seems a promising treatment approach showing, in the short term, an important clinical benefit and good safety. Funding Statement: None. Declaration of Interests: All authors declare no conflict of interest with the submitted manuscript. Ethics Approval Statement: Sarilumab was administered according to a shared clinical-pharmacological protocol (Prot.n.926 approved by the Ethics Comittee of the Fondazione Policlinico Universitario A. Gemelli-IRCCS, Universita Cattolica del Sacro Cuore). Each patient or next of kin provided informed consent.

Pathological Findings in Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Single-Center Experience.

Objective: Segmental demyelination is the pathological hallmark of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), but other elementary lesions are frequently observed, configuring a series of different pathological pictures. In this article, we review the pathological findings of a large series of sural nerve biopsies from our cohort of CIDP patients. Patients and Methods: Patients with CIDP who underwent nerve biopsy were retrospectively selected from those referred to the Institute of Neurology of the “Università Cattolica del Sacro Cuore” in Rome, Italy, from 1982 to February 2020. Sural nerve biopsy was performed according to standard protocols. Results: Sural nerve biopsy was performed in 43/130 CIDP patients. Demyelinating abnormalities and axonal loss were found in 67.4% and 83.7% of biopsies, respectively. Conversely, onion bulbs and inflammatory infiltrates were rare (18.6% and 4.7%, respectively). In three cases, we observed normal pathological findings. Conclusions: A pathognomonic pathological finding of CIDP cannot be established, but we confirm the utility of nerve biopsy in this setting to confirm the diagnosis (also in atypical phenotypes) and to elucidate pathogenic mechanisms.

Mycotoxins in maize: mitigation actions, with a chain management approach

This review was prepared as part of MYCHIF EFSA project (GP/EFSA/AFSCO/2016/01). Roberta Palumbo carried out this work within the PhD school Agrisystem of Universita Cattolica del Sacro Cuore, Italy. This study was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UID/BIO/04469 unit and COMPETE 2020 (POCI-01-0145-FEDER-006684) and BioTecNorte operation (NORTE-01-0145-FEDER-000004) funded by the European Regional Development Fund under the scope of Norte2020 - Programa Operacional Regional do Norte. This paper was critically reviewed in collaboration with MycoKey project (Horizon 2020, Grant Agreement No. 678781).

Household Disinfectant Exposure During the COVID-19 Pandemic: A Retrospective Study of the Data from an Italian Poison Control Center

Background: Since the beginning of the COVID-19 pandemic it has been recommended that chemical disinfectants are used to protect surfaces. This study aimed to determine whether the number of exposure calls related to household disinfectants (HD) received between January 30, 2020 to May 18, 2020 varied from the same time period in the previous year.Method: A retrospective review of the poison control centers database from the Fondazione Universitario Policlinico Agostino Gemelli IRCCS was conducted. Calls from Italian citizens, hospitals, and general practitioners received during the same time period in 2019 and 2020 were compared.Findings: The center received 1972 exposure calls during the study period. A 5% increase in calls regarding exposure to HDs was noted from 2019 to 2020 (9·8% to 15·2%, pInterpretation: As the incidence of enquiries regarding products that can represent an important health hazard, when improperly used, increased in 2020 suggests that the COVID-19 public health messaging on the proper use of HDs should be improved.Funding Statement: This work has been supported by Fondi di Ateneo, Linea D1 – Università Cattolica del Sacro Cuore, Grant n. R4124500772 (Recipient: Antonio Oliva). Declaration of Interests: There are no conflicts of interest to declare.Ethics Approval Statement: The authors state that no approval from ethics committee was required.

EXPLORING THE VOCABULARY LEARNING STRATEGIES OF ITALIAN LEARNERS OF ENGLISH

Author/s
 James RockUniversità Cattolica del Sacro Cuore di Milano, Italy
 
 ABSTRACT
 In this paper, a think-aloud protocol is used to explore the vocabulary learning strategies of ten adult learners of English at a university in the north of Italy. The focus is on discovering the types of actions that are actually employed by learners while performing a deliberate vocabulary learning task. As well as providing information about frequency of use, the investigation revealed some patterns of strategy use. In general, less attention was awarded to techniques involving deeper mental elaboration, such as complex guessing for meaning or the use of mnemonic techniques, in favour of strategies requiring less mental effort. There was also less emphasis on mechanical repetition than in many previous studies on the topic.

ACUTE GRAFT Versus Host Disease 1990-2017: Reduced Incidence and Predictive Factors

Alessandra Di Francesco1 , Anna Maria Raiola2 , Alida Dominietto2 , Carmen Di Grazia2, Francesca Gualandi2, Maria Teresa Van Lint2, Patrizia Chiusolo1, 3, Luca Laurenti1, 3, Federica Sora'1, 3, Sabrina Giammarco1 , Elisabetta Metafuni1 , Emanuele Angelucci2 , and Andrea Bacigalupo ,3 1Istituto di Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma Italy 2IRCCS Policlinico San Martino, Genova, Italy 3Universita' Cattolica del Sacro Cuore, Roma, Italy; Background: Acute Graft versus Host Disease (GvHD) is a major complication of allogeneic HSCT, and prophylaxis has significantly changed in time . Aim of th study: we wanted to determine the cumulative incidence of GvHD and its outcome, in 3 periods :<2000; 2000-2010; >2010, together with predicting factors. Methods: we analyzed 3126 patients allografted in 2 transplant Centers between 1976 and 2018. Median age increased over the 3 periods from 32 (1-66) to 42 years (9-71) to 50 years (range13-74) (<0.00001). Results GvHD timing : The median day of onset of GvHD before year 2000 was day +14 (2-90), between 2001 and 2010 it was day +19 (2-98) and beyond year 2010 it was day +33 (2-98) (p<0.0001). There were 237 patients developing GvHD before day 14 before year 2000, 71 patients between 2001 and 2010 and only 8 patients beyond 2010 (p<0-0001). GvHD cumulative incidence. The cumulative incidence (CI) of GvHD grade II-IV was 47% before 2000, 24% between 2000 and 2010, and 16% after 2010 (p<0.00001). The CI of GvHD grade III-IV was 13%, 5%, 4% respectively in the three periods (p<0.001). Survival at 5 years of patients with GvHD grade II has remained unchanged in the 3 periods (52%, 44%, 55%, respectively , p=0.2); survival of patients with GvHD grade III-IV has improved from 15%, to 30% and 23% respectively (p=0.003). GvHD and donor type. The incidence of GvHD grade II-IV in HLA identical siblings (SIBS) was 25%, 19% and 14% in the 3 periods (p=0.0005), and for alternative donors, these figures were 43%, 34%, 21% (p<0.00001). Transplant related mortality (TRM). The CI of TRM for patients with grade II GvHD has not changed significantly (27%, 25%, 20%, p=0.1) whereas TRM for patients with GvHD grade III-IV has been reduced from 70% (<2000) to 49% (2001-2010) to 26% beyond year 2010 (p=0.002). Multivariate analysis on survival for patients with grade II GvHD . Significant predictors of survival, for patients with GvHD grade II, were the day of onset of acute GvHD (</>day 14), advanced phase of the disease, transplant year before year 2000, patients age over 60, and a donor other than an HLA identical sibling. When adding together these negative predictors , the 5 year survival was 28% for patients with 3-5 negative predictors, as compared to 56% for patients with 0-2 negative predictors Conclusions. We show a very significant reduction of the CI of GvHD with time, together with a very significant delay of the onset of the disease. TRM has been reduced in patients with grade III-IV GvHD, less so in patients with GvHD grade II. In the latter significant clinical predictors may allow the identification of patients at high risk, eligible for treatment protocols. Disclosures No relevant conflicts of interest to declare.

1541P - PTEN loss as predictor of tumour heterogeneity (TH) and poor prognosis in EGFR-mutant advanced non-small cell lung cancer (ANSCLC) patients (pts) receiving tyrosine-kinase inhibitors (TKIs)

BackgroundAlthough the dramatic activity of EGFR TKIs for EGFR-mutant ANSCLC, nearly 20% of pts do progress rapidly. Poor prognosis was demonstrated to be associated with TH, which may be mirrored by the co-existance of concomitant mutant drivers, such as PTEN. The aim of this analysis was to investigate the correlation between the loss of function of PTEN (as a mirror of TH), and the activity/efficacy of EGFR-TKIs for advanced EGFR mutant ANSCLC pts. MethodsFFPE-tumor blocks of EGFR-mutant ANSCLC pts undergone upfront TKIs from 2015 to 2017 were retrospectively collected (follow-up >18mo. was required for maturity). The status of 4 genes (PTEN, TP53, c-MET, IGFR) was evaluated by immunohistochemistry (IHC) and it was correlated with objective response rate (ORR), overall- and progression-free-survival (OS/PFS). Kaplan-Maier (KM) analysis was performed for independent factors at multivariate analysis. ResultsForty-two EGFR-mutant ANSCLC pts were included [median age 65 yrs (42-86); M/F: 45/55%; current/former/never smoker: 13.5/35/51.5%; PS (ECOG) 0/1/2/3: 30/55/12.5/2.5%; GEF/AFA/ERL: 72.5/25/2.5%; del19/L858R/rare: 60/35/5%]. At multivariate analysis, PTEN loss (HR 6.02, 95% CI 2.48-14.5, p<0.0001) and metastatic sites >2 (HR 2.38, 95% CI 1.01-5.62, p=0.048) were significantly associated with shorter PFS. At KM analysis, pts with PTEN loss (13) had a median PFS of 2.0mo. (95% CI 0-5.4) and a 1-year PFS of 7.7%, in comparison with pts without (27), median PFS 18.3mo. (95% CI 16.5-20.1), 1-year PFS 69.6% (log-rank p<0.0001). Coherently, at the multivariate analysis, PTEN loss (HR 5.11, 95% CI 2.06-12.6, p<0.0001) and PS of 2-3 (HR 6.57, 95% CI 2.01-21.5, p<0.002) were significantly associated with shorter OS. Pts with PTEN loss had a median OS of 4.5mo. (95% CI 0.2-8.9) and a 1-year PFS of 15.4%, in comparison with pts without, median OS 26.9mo. (95% CI 16.7-37.1), 1-year OS 81.5% (log-rank p<0.0001). ConclusionsA low-cost and reproducible IHC assay for PTEN-loss analysis represents a potential tool for identifying TH of EGFR-mutant ANSCLC pts. A powered clinical validation is currently ongoing. Legal entity responsible for the studyEmilio Bria. FundingComprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. DisclosureE. Bria: Advisory / Consultancy: Roche; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: MSD; Research grant / Funding (institution): AstraZeneca. All other authors have declared no conflicts of interest.

The importance of rapid diagnosis for multidrug-resistant Candida: an interview with Maurizio Sanguinetti.

In this exclusive interview, Maurizio Sanguinetti discusses current issues with Candida fungal infection diagnoses, in light of its rising resistance to antifungal drugs. This interview was conducted by Ellen Colvin, Editor of Future Microbiology. Maurizio Sanguinetti, MD, is full Professor of Microbiology at the Università Cattolica del Sacro Cuore of Rome, Italy, and Director of the Institute of Microbiology and Chief of the Department of Laboratory Sciences and Infectious Diseases Sciences at the Fondazione Policlinico Agostino Gemelli IRCCS of Rome, Italy. For several years, the research activity of Maurizio Sanguinetti has mainly focused on the development of molecular methods for the rapid diagnosis of bacterial, mycobacterial and fungal infections; the elucidation of virulence and antimicrobial resistance mechanisms in clinically relevant bacterial and fungal pathogens; the characterization of the human microbiota in relationship to infectious and noninfectious diseases and implementation of new diagnostic strategies for the personalized care of patients with infectious diseases.

Ageing as a mindset: a study protocol to rejuvenate older adults with a counterclockwise psychological intervention

IntroductionAlthough ageing is generally perceived as a biologically determined process, the literature increasingly points to the importance of psychological factors in the ageing process, specifically age-related stereotypes or cognitive mindsets....

Effect of single anastomosis duodenal-ileal bypass with sleeve gastrectomy on glucose tolerance test: comparison with other bariatric procedures

BackgroundNo data have been reported regarding the risk of hyperinsulinemic response and reactive hypoglycemia after single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S). Furthermore, comparative studies with other bariatric procedures are lacking. ObjectivesTo compare response to oral glucose tolerance test (OGTT) in patients who underwent SADI-S, Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and biliopancreatic diversion (BPD). SettingFondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome. MethodsConsenting, nondiabetic patients matched for age, sex, and preoperative body mass index, who underwent SADI-S, RYGB, SG, and BPD, were recruited. A 75 g OGTT was performed pre and postoperatively. Plasma insulin and glucose (pGlu–mg/dL) were measured at baseline, and at +30, +60, +90, +120, +150, and +180 minutes. Severe hypoglycemia was defined as pGlu concentration <55 mg/dL. ResultsThirty-five patients were recruited: 9 SADI-S, 11 RYGB, 7 SG, and 8 BPD. Comparing preoperative and postoperative responses to OGTT, all procedures improved the glycemic control with better early results after SADI-S and BPD compared with RYGB and SG. No patients showed severe hypoglycemia. Significantly more patients who underwent RYGB and SG showed asymptomatic pGlu <70 mg/dL during OGTT compared with SADI-S and BPD (63.6% and 57.1% vs 22.2% and 12.5%, respectively, P < .05). ConclusionsSimilar to BPD, SADI-S seems to be associated to insulin sensitivity and glucose homeostasis improvement, together with a reduced risk of hyperinsulinemia and, consequently, to hypoglycemia, often associated with RYGB and SG.

"Hormone of darkness" and human reproductive process: direct regulatory role of melatonin in human corpus luteum.

To investigate the possible role of melatonin on human luteal cell function. Corpora lutea were obtained from normally menstruating women (25-38years old) in the midluteal phase (days 5-6 from ovulation) at the time of surgery for non-endocrine gynecologic diseases. The protocol was approved by the institutional review board of Università Cattolica del Sacro Cuore in Rome and all patients provided written informed consent. The corpora lutea were dated on the basis of the presumptive day of ovulation (day 0) , determined by urinary luteinizing hormone (LH) peak, ultrasound detection of corpus luteum or disappearance of the dominant follicle, and a rise in the plasma P concentration. ELISA or EIA kit and immunohistochemistry were performed. Melatonin was able to increase progesterone release and to influence the balance between luteotrophic and luteolityc factors. In addition, melatonin expression and MT2 receptor were detected, confirming the direct action of this indoleamine on CL. Melatonin may play an intriguing role in direct regulation of CL function and in establishing and maintaining of initial pregnancy. In conclusion, melatonin could become a relevant medication for improving ovarian and luteal function and in the early stages of pregnancy, opening new opportunities for the management of several ovarian-luteal and pregnancy diseases.

Correction to: Posterior cranial fossa and spinal local infections

Unfortunately in the original publication, the affiliation provided for the author G. Tamburrini was incorrect. The correct affiliation for G. Tamburrini should read as follows: Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy.

Unindo Mundos: A Screenwriting Research Network Conference

Em setembro de 2018, a 11.ª edição da Screenwriting Research Network Conference teve lugar na Università Cattolica del Sacro Cuore de Milão. Entres as diversas atividades de pré-conferência e conferência, salientam-se tendências como o estudo das séries TV, a investigação practice-based, análise fílmica quantitativa ou processos de escrita e criação.

New Trends in the Definition of Permanent Establishment: The Netherlands

This paper elaborates on current and emerging issues involving the operation of the concept of permanent establishment (PE) in the national tax system and double tax treaty system of the Netherlands. The paper was written as a contribution (country report) to the seminar “New Trends in the Definition of Permanent Establishment”, organized by the Faculty of Economics and Law of the Universita Cattolica Del Sacro Cuore under the aegis of the OECD and the Italian Council of Ministers. The seminar was held in Milan, Italy, on 26 November 2018. Topics addressed in the paper include: • The operation of the PE concept in the national tax system and double tax treaty system • Tax treaty practices and departures from the OECD Model • Signing of the Multilateral Instrument and reservations made and options chosen • Ongoing developments • Taxation of the digital economy

A survey of dairy cattle management, crop planning, and forages cost of production in Northern Italy

A survey regarding crop enterprise management, forages cost of production, dairy cattle management including reproductive management, housing, heat abatement, body condition scoring, nutrition, grouping strategies, and income over feed cost performance, was carried out from December 2016 to January 2018 on 50 dairy farms by the Department of Animal Science, Food and Nutrition of Università Cattolica del Sacro Cuore (Piacenza, Italy). A total of 41 herds (82%) completed the survey. Average herd size was 327 ± 162 lactating cows with the average land size of 160 ± 94 ha per farm. Herds were located in the provinces of Cremona (17), Brescia (8), Mantova (7), Piacenza (5), Cuneo (4), Bergamo (3), Lodi (3), Torino (2), and Venezia (1). These farms sold 32.8 ± 2.01 kg of milk/day per cow, had an annual culling rate of 34.0 ± 4.00%, a calving interval of 14.16 ± 0.58 months., and a 21-days pregnancy rate of 17.05 ± 2.58%. Implementing effective management strategies to contrast the damage caused by Ostrinia nubilalis, Diabrotica spp. and Myocastor coypus were identified as the main crop enterprise challenges. Main forages cultivated were alfalfa and corn silage second seeding with a total cost of production of (€/ha) 1968 ± 362 and 2,581 ± 221, with an average yield of 9.61 ± 1.24 and 17.22 ± 2.46 ton of DM per hectare, respectively. Results of this study can provide useful benchmark or reference for dairy management practices, crops and dairy performances, forages production costs on very well-managed North Italian dairy farms at the present time.Highlightsbenchmarks for dairy farmsmanagement practices, economic and reproductive performancecost of production of forages in northern Italy

Characterization of the Ear Canal Bacterial Flora Present in Hearing Aids (HA) Wearing Subjects

The use of hearing aids (HA) is considered a predisposing factor for ear microbial infections. We undertook this study to compare the presence and nature of the microbial flora inhabiting of ears of HA and non-HA (nHA) users. Swab samples of the ears of HA and nHA users were collected from the Institute of Otolaryngology, “Cattolica del Sacro Cuore” University “Agostino Gemelli”, Rome, Italy. Swab samples were taken from the ear canal of 57 HA and 33 nHA users. The components of the microbial flora present on each swab sample were identified and characterized at the level of species. A total of 41 different bacterial species were identified. A statistically significant prevalence of polymicrobial communities was found in ears presenting signs of inflammation (2.5 ± 1.7 vs 2.1 ± 1.3; P = 0.02) and in HA users (2.3 ± 1.2 vs 1.7 ± 1.0; P = 0.002). Few putative pathogens were detected. Candida albicans spp. was not isolated in our study. A small number of swab samples presented no microbial growth. Bacterial species isolated from HA users with and without inflammation were assayed for the ability to form biofilm. Among gram-positive and gram-negative bacteria, S. aureus, CoNS, P. aeruginosa and K. pneumoniae were found to be strong biofilm producers. S. aureus and P. aeruginosa, isolated only from the ears of HA and nHA users presenting signs of inflammation, were further analyzed for their antibiotic-resistance profile and characterized by the Multilocus Sequence Typing (MLST) assay. The highest rates of antibacterial resistance were in S. aureus to penicillin (75.5%) and in P. aeruginosa, to amoxicillin-clavulanic acid, cefotaxime, ertapenem, tigecycline and trime-thoprim-sulfamethoxazole (100%). Moreover, three S. aureus strains (37.5%) were methicillin-resistant (MRSA). Of the eight S. aureus isolates, we identified six sequence types (ST) indicating that 75% are likely independent clones. For what it concerned P. aeruginosa, six different STs were assigned. Interestingly, two out of the six strains presented newly identified ST values. This study sheds new light on the combined effect of the presence of HA devices and signs of external ear inflammation on the composition of the ear bacterial flora. Our results reinforce the need to practice careful hygiene of HA devices to prevent serious ear canal infections.