Long term mortality and morbidity of Italian soldiers after deployment in Iraq as related to biomarkers assessment: Results of the SIGNUM study.

INTRODUCTION: The health profile of military veterans deployed in foreign operative theatres was assessed by several international studies because of potential exposure to depleted uranium and other pollutants. Here we reported results of 15-year epidemiological surveillance assessing long-term health effects in a cohort of Italian soldiers deployed in Iraq in 2004-2005 and participating in a biomonitoring campaign to identify potential genotoxic exposure to environmental xenobiotics before and after deployment (n = 981, SIGNUM cohort). METHODS: We evaluated mortality and hospitalization risks of the SIGNUM cohort retrospectively until 2016 and 2018 respectively. A wide cohort of military personnel never deployed abroad (n = 114,260) and the general Italian population were used as control populations in risk assessment. Causes of death and diagnoses of hospitalization were derived through deterministic record linkage with official national databases of mortality and hospital discharge. Standardized Mortality Ratio (SMR) and Standardized Hospitalization Ratio (SHR) were computed adjusting according to sex, age, area of birth, and calendar year. Differential pre-post deployment in xenobiotics concentrations and early effect biomarkers (oxidative DNA alterations and micronuclei) measured in blood serum were analysed in relation to cancer hospitalization. RESULTS: Mortality risk due to pathologies was more than halved compared to the general population (SMR = 0.41, 95% CI 0.11-1.05) and not significantly different compared to soldiers never deployed abroad (SMR = 0.69, 95% CI 0.19-1.68). Similarly overall hospitalization risk due to pathologies was decreased with respect to the general population (SHR = 0.86, 95% CI 0.80-0.92) and comparable to the control military group (SHR = 0.99, 95% CI: 0.93-1.06). For haematological cancers a decreased hospitalization risk compared to the Italian general population was observed (SHR = 0.38, 95% CI 0-0.92). No statistically significant differences emerged in the patterns of biomarkers in association with cancer hospitalization. CONCLUSION: The study confirms the so called 'healthy warrior' effect for the SIGNUM veterans and showed no correlation between cancer occurrence and biomonitoring markers measured on field.

A case of dengue type 3 virus infection imported from Africa to Italy, October 2009.

In October 2009, a traveller returning from Africa to Italy was hospitalised with symptoms suggestive of a haemorrhagic fever of unknown origin. The patient was immediately placed in a special biocontainment unit until laboratory investigations confirmed the infection to be caused by a dengue serotype 3 virus. This case reasserts the importance of returning travellers as sentinels of unknown outbreaks occurring in other countries, and highlights how the initial symptoms of dengue fever resemble those of other haemorrhagic fevers, hence the importance of prompt isolation of patients until a final diagnosis is reached.

[Aero-transport of a MDR-TB affected patient with bio-containment systems]. / Il trasporto aereo di un paziente affetto da tubercolosi multiresistente mediante sistemi di bio-contenimento.

The Italian Air Force medical service, in order to attend to its duty, has to deal with the search, rescue and aero-medical evacuation of the wounded and sick. Due to the increase of air transportation, the likelihood of contracting disease, such as haemorrhagic fevers has risen and it is necessary to know how to treat a patient abroad suffering from severe infectious disease without running any risk either for the medical personnel or for the air crew. The military sanitary service of the Air Force has been preparing for this purpose through a meticulous preparation in Italy and in the USA in order to satisfy these need and through the use of stretchers specifically designed to transport highly contagious patients: Aircraft Transit Isolators (ATIs) and Stretcher Transit Isolators (STIs). These particular medical tools are provided by filter HEPA and they are completely insulated in a PVC envelope. The former (ATI) is used to transport the patient by airplane, the latter is used for road travel. Last January 24th the first real mission was performed transporting a severe TBC-MDR (case) from Alghero to Milan. All went well and the patient left the hospital of Sondalo two months later.

[New trends in chemotherapy of human hydatid disease]. / Progressi nella terapia medica della idatidosi umana.

The Authors report the current trends in chemotherapy of human hydatid disease, reviewing the most important papers and in particular their own experience, based on treatment with benzoimidazole carbamates of 425 patients affected by hydatid disease. The Authors particularly describe the factors that can influence the outcome of chemotherapy, such as: the drug used and their posology, the age of the cysts and or of the patients, cyst morphology and localization etc.

[Verapamil versus flunarizine in the preventive therapy of hemicrania]. / Verapamil versus flunarizina nella terapia preventiva dell'emicrania.

In this single-blind, parallel group study, the efficacy of verapamil (240 mg/die) vs flunarizine (10 mg/die) for prophylactic treatment was evaluated in 38 patients (8M and 30F, mean age 34.4 years) with common or classic migraine. During the 3 months study, both drugs were found to be effective in reducing the number and intensity of the attacks. Verapamil showed better safety than flunarizine.

[A hypothesis on the significance of an increase in serum transaminases in patients with hydatidosis treated with benzimidazole carbamates]. / Ipotesi sul significato dell'aumento delle transaminasi sieriche in pazienti con idatidosi umana trattati con benzoimidazolici carbamati.

Increase of aminotransferases was observed in 58 out of 448 patients with hydatid disease without other risk factors (28 males and 30 females) during treatment with mebendazole and albendazole; all these patients had liver cysts. The enzymatic increase was always reversible and slight (ranged from 2-4 folds the normal values in most of patients), even without stopping treatment; it was less frequently observed during further cycles of therapy and it was never observed after surgical asportation of the cysts. Jaundice was never observed. The increase of transaminases appeared to be significantly correlated to effectiveness of therapy and to the earlier occurrence of degenerative modifications of the hydatid cysts. The authors hypothesize that besides hepatoxicity (in cases of marked increase of aminotransferases or in patients without liver cysts) slight increase of transaminases could be due to pericystic inflammation secondary to the marked host's immunitary reaction, and so could be considered as an index of therapeutic effectiveness.

[Advances of medical treatment of human hydatidosis]. / Progressi nella terapia medica della idatidosi umana.

The Authors report the current trends in chemotherapy of human hydatid disease, on the basis of their own experience, concerning the medical treatment of 425 patients affected by hydatid disease. The Authors describe the factors that can influence the outcome of chemotherapy, such as: the drugs used and their posology, the age of the cysts and/or of the patients, cyst's morphology and localization.

Detection of interleukin-2 in addition to interferon-gamma discriminates active tuberculosis patients, latently infected individuals, and controls.

Effective control of tuberculosis (TB) includes discrimination of subjects with active TB from individuals with latent TB infection (LTBI). As distinct interferon (IFN)-gamma and interleukin (IL)-2 profiles of antigen-specific T-cells have been associated with different clinical stages and antigen loads in several viral and bacterial diseases, we analysed these cytokines in TB using a modified QuantiFERON-TB Gold In Tube test. Detection of IL-2 in addition to IFN-gamma distinguishes not only Mycobacterium tuberculosis-infected subjects from healthy controls, but also individuals with LTBI from active TB patients. This may help to improve diagnostic tests for TB.

European concepts for the domestic transport of highly infectious patients.

Highly infectious diseases involve clinical syndromes ranging from single to multiorgan infections and pose a constant threat to the public. In the absence of a definite treatment for most causative agents, patients benefit from maximum supportive care as clinical conditions may deteriorate in the short term. Hence, following initial case identification and isolation, rapid transportation to a specialized treatment unit must be considered in order to minimize the risk of secondary infections, but this is limited by available infrastructure, accessible care en route and the patient's clinical condition. Despite the development of consensus curricula for the clinical management of highly infectious patients, medical transportation lacks a common European approach. This article describes, as examples, three current European concepts for the domestic relocation of highly infectious patients by ground vehicles and aircraft with respect to national legislation and geography.

Therapy of human hydatid disease with mebendazole and albendazole.

We report our experience in the treatment with benzoimidazole carbamates (mebendazole and albendazole) of 337 patients affected by hydatid cysts with different localizations. The treated cysts showed degenerative modifications in 50.6% of the cases after mebendazole treatment and in about 80% after albendazole treatment. Relapses after therapy were observed in 30% of the cases; about 95% of the recurring cysts showed good susceptibility to a further cycle of therapy with benzoimidazole carbamates. Side effects observed with either drug were not severe and always reversible, consisting mainly of abdominal pains and increased levels of transaminases in serum. Among the factors that may influence the therapeutic results are the drug employed, the age of the cysts, the age of the patient, and the localization of the cysts and their morphological characteristics. Moreover, it can be hypothesized that each hydatid cyst has an intrinsic sensitivity to benzoimidazole carbamates.