Blood and body fluids exposure of healthcare workers in a university hospital of Palermo, Italy: a fourteen years long surveillance.

BACKGROUND: Healthcare workers are habitually in direct contact with patients, possible carriers of infectious diseases and with potentially infectious biological materials; therefore, the implementation of standard precautions and good working practices represent an intervention strongly recommended by the Centers for Disease Control and Prevention, and required by Italian law, for the prevention of professional cut wounds. The study focused on assessing the exposure frequency and factors related to biological injuries among healthcare workers in a teaching hospital in Palermo, Italy. METHODS: We performed a 14-years retrospective descriptive analysis on blood and body fluids exposures in healthcare workers, documented by questionnaires administered at the time of injury and by data collected during the follow-up period. The questionnaire included questions concerning personal data (age, sex), job position (role, employment contract, ward), biological exposure (type of exposure, devices used and circumstance of blood and body fluids exposure), precautions adopted (personal protecting equipment, safety devices) and vaccination status. RESULT: A total amount of 899 healthcare workers was investigated. The incidence rate per 100 beds was 10.7. Frequency of exposure to blood and body fluids among healthcare workers was 35.3% in nurses, 31.7% in physicians, 17.6% in students. The mean age of injured healthcare workers was 36 years. The most common blood and body fluids exposures were represented by needlestick injury (76.2%), splash and spill (15.0%) and sharp (8.3%). 585 out of 685 percutaneous exposures were caused by needles (syringe, peripheral venous catheter, butterfly needles, etc.) and occurred mainly to nurses (N=224, 38.3%), physicians (N=184, 31.4% of whom resident physicians=122, 20.1% and hospital doctors=62, 10.6%), students (N=96, 16.4%) and auxiliary personnel (N=77, 13.1%). No seroconversion among exposed healthcare workers was recorded in the whole survey period. Twenty-four healthcare workers (2.6%) received post-exposure prophylaxis against Hepatitis B Virus. CONCLUSION: To our knowledge, this is the first long-term survey on blood and body fluids exposure in Southern Italy. Nurses are the most commonly affected group by biological injuries. Resident physicians and students follow the nurses probably due to a lack of training and experience about biological risk. These last two groups, however, seem to have more awareness of blood and body fluids exposures to which they are susceptible during their training cycle; in fact, they mostly use personal protective equipment compared to other healthcare workers. The blood and body fluids exposures are a preventable and a major occupational hazard in healthcare. This focus highlights the need for interventions to enhance the occupational safety of workers and students.

Epidural Needle Extension through the Ligamentum Flavum Using the Standard versus the CompuFlo®-Assisted Loss of Resistance to Saline Technique: A Simulation Study.

BACKGROUND: The CompuFlo® epidural system has been recently introduced and validated as an objective and sensible tool to detect the epidural space. We aimed to verify whether the high sensitivity of the instrument may help the anesthesiologist to identify the epidural space very early, limiting the extension of the Tuohy needle into the epidural space. METHODS: In this prospective, simulation study, we evaluated the Tuohy needle extension through a simulated ligamentum flavum during the epidural procedure performed by 52 expert anesthesiologists by using the CompuFlo® epidural instrument or their standard loss of resistance to saline technique (LORT). RESULTS: The mean (SD) needle extension length was 3.90 (3.71) mm in the standard technique group and 0.68 (0.46) mm in the CompuFlo® group (P < 000001). The extremely reduced variability of the data in the CompuFlo® group (F test 0.01) made the results obtained with this instrument highly predictable. CONCLUSIONS: Puncturing high-resistance material that simulated the ligamentum flavum, the use of CompuFlo® has determined the arrest of the needle more precociously when compared with the traditional LORT.

Experimental validation of the CompuFlo® epidural controlled system to identify the epidural space and its clinical use in difficult obstetric cases.

BACKGROUND: This prospective study was designed to validate the CompuFlo® device and to assess its use in difficult epidural placement. METHODS: In the first part of the study, 30 parturients requesting labor epidural analgesia were recruited. The block was performed by an expert anesthesiologist, with the Tuohy needle connected to the CompuFlo® device to evaluate the agreement between the anesthesiologist's reported sensation and the variation of pressure recorded by the CompuFlo®. In the second part of the study, 56 consecutive parturients, for whom at least two complete needle reinsertions were made by trainees during epidural placement for labor analgesia, were enrolled. CompuFlo® was used as a rescue tool for the subsequent attempt. RESULTS: In all cases epidural analgesia was successful and no complications were noted. There was a good correlation between the operator's feelings and the delta of pressure recorded by the CompuFlo®, for both identification of the ligamentum flavum and of the epidural space (Rho = 0.79; tau = 0.67). In the second part of the study, all the difficult blocks performed with the CompuFlo® were successful after a single attempt. The pressure curves of false loss-of-resistance were significantly different from the true loss-of-resistance (P <0.0001) DISCUSSION: CompuFlo® was validated as a tool to identify the epidural space. It may also assist trainees in successful epidural placement in difficult cases.

Identification and characterization of a galactosyl peptide mimetic. Implications for use in removing xenoreactive anti-A Gal antibodies.

Gal alpha 1,3 Gal is thought to be the major antigenic epitope present on pig tissues to which XNAs bind. Removal of antibodies directed against that structure may be critical to the success of pig to human xeno-transplantation. As a first step toward the development of ligands capable of removing XNAs, we have used a phage-displayed peptide library to identify a six-amino-acid peptide that binds to the lectin GS-1-B4 (which binds the carbohydrate Gal alpha 1,3 Gal). This peptide blocks the binding of GS-1-B4 to pig aortic endothelial cells. The carbohydrate Gal alpha 1,3 Gal competes with the binding of GS-1-B4 to the peptide, suggesting that they may bind the same site. Using a RBC agglutination assay, we show that this peptide inhibits the agglutination of pig RBCs by heat-inactivated human serum at concentrations similar to that of Gal alpha 1,3 Gal.

[Serum and immunological markers of progression to acquired immunodeficiency syndrome in hemophiliacs]. / Marcadores séricos e inmunológicos de progresión a síndrome de inmunodeficiencia adquirida en hemofílicos.

In a cohort of 30 randomly selected hemophiliacs who were prospectively controlled for four years the predictive value of AIDS development was evaluated for serum markers of HIV infection and for lymphocytic subpopulations in peripheral blood. The patients were evaluated with a mean of 15.79 +/- 5.74 months, and overall antibodies, specific antibodies (anti-ENV and anti-p24), HIV antigen (Ag HIV) and lymphocyte subpopulations were determined. 50% of the hemophiliacs with positive serum Ag HIV (2/4) developed AIDS during the study, whereas this progression was not recorded in any anti-HIV positive, nonantigenic patient. The presence of Ag-HIV was detected at least two years before the diagnosis in these patients, and it was associated with the absence of anti-p24 in one or more determinations. The immune regulation parameters were not significantly different, at the beginning of the study, in the hemophiliacs who developed AIDS and in those who did not. However, the progression to AIDS was associated with a significantly smaller T4/T8 ratio at least one year before the diagnosis. Our results show that the development of AIDS in hemophiliacs is associated both with the presence of Ag-HIV in the serum and a reduction in the T4/T8 ratio, although the detection of the former appears to be earlier than that of the latter in this risk group.

Differences in NMDA receptor antagonist-induced locomotor activity and [3H]MK-801 binding sites in short-sleep and long-sleep mice.

Short-Sleep (SS) and Long-Sleep (LS) mice differ in initial sensitivity to ethanol. Ethanol acts as an antagonist at N-methyl D-aspartate receptors (NMDARs). Therefore, we tested whether SS and LS mice also differ in initial sensitivity to NMDAR antagonists. Systemic injection (intraperitoneal) of either the noncompetitive NMDAR antagonist MK-801 (dizocilpine) or the competitive NMDAR antagonist 2-carboxypiperazin-4-yl-propyl-1-phosphonic acid (CPP) produced similar results. At lower drug doses, SS mice showed greater locomotor activation than LS mice; and at higher doses, SS mice continued to be activated whereas LS mice became sedated. Brain levels of [3H]MK-801 were 40% higher in SS, compared with LS, mice. However, blood levels of [3H]MK-801 and [3H]CPP and brain levels of [3H]CPP were similar in the two lines. NMDARs were measured using quantitative autoradiographic analysis of in vitro [3H]MK-801 binding to SS and LS mouse brains. Significantly higher (20 to 30%) receptor densities were observed in the hippocampus and cerebral cortex of SS mice. Our results support the hypothesis that SS and LS mice differ in initial sensitivity to NMDAR antagonists and suggest that the line differences in the dose-response relationships for MK-801- and CPP-induced locomotor activity are qualitatively similar to those reported for ethanol. Differences in pharmacokinetics and number of NMDARs may contribute to, but are unlikely to entirely account for, the differential behavioral responsiveness of SS and LS mice to MK-801 and CPP.

The presence of UDP-N-acetylglucosamine:alpha-3-D-mannoside beta 1,2-N-acetylglucosaminyltransferase I activity in Spodoptera frugiperda cells (IPLB-SF-21AE) and its enhancement as a result of baculovirus infection.

A Golgi preparation from Spodoptera frugiperda (IPLB-SF-21AE) cells was incubated in the presence of the mannosidase II inhibitor, swainsonine, with the oligosaccharide, M(alpha 1,3)[[M(alpha 1,3)[M(alpha 1,6)]M(alpha 1,6)]] M(beta 1,4)Gn(beta 1,4)Gn (M5Gn2), the preferred substrate for the enzyme, UDP-N-acetylglucosamine:alpha-3-D-mannoside beta 1,2-N-acetylglucosaminyltransferase I (Gn-TI). This resulted in formation of the product, Gn(beta 1,2)M(alpha 1,3)[[M(alpha 1,3)[M(alpha 1,6)]M(alpha 1,6)]]- M(beta 1,4) Gn(beta 1,4)Gn (Gn(I)M5Gn2). A significantly increased (> 4-fold) rate of conversion of M5Gn2 to Gn(I)M5Gn2 occurred with insect cell-derived Golgi preparations that had been infected with a recombinant baculovirus for 66 h, a time at which significant amounts of complex-type oligosaccharides were assembled on a heterologous protein, human plasminogen, expressed in this system. Coupled with previous results (Davidson, D.J., Bretthauer, R.K., and Castellino, F.J. (1991) Biochemistry 30, 9811-9815) that demonstrated the occurrence of virally induced activation of a specific M6-mannosidase in IPLB-SF-21AE cells, it is clear that viral infection of lepidopteran insect cells makes available enzymes that provide and utilize the substrate, M5Gn2-protein. This is a key feature in the explanation of the previous original observations made by this laboratory, that lepidopteran insect cells are capable of assembly of complex-type oligosaccharides on glycoproteins.

Ginecomastia en adolescentes, condiciones clínicas asociadas a impacto emocional / Ginecomasty in adolescents, clinicals conditions associated to emotional impact

Introducción: Ginecomastia es la proliferación benigna del tejido mamario masculino. Se presenta en el 50% de los hombres; un estudio en población adolescente informa una prevalencia del 3,9%. Pese a ser un evento puberal puede producir baja autoestima y menor participación en actividades grupales. Objetivos: 1)Conocer la prevalencia de ginecomastia en los adolescentes que consultan al Servicio de Adolescencia del Hospital de Niños Ricardo Gutiérrez, de CAB; 2)describir la relación entre ginecomastia, índice de masa corporal y estadío de maduración sexual de Tanner; 3)evaluar la presencia de enfermedades subyacentes, consumo de medicamentos y/o sustancias de abuso; y 4)evaluar el impacto emocional de la misma en el adolescente. Metodología: Estudio descriptivo, prospectivo y transversal. Se evaluaron 789 varones de 13 a 17 años entre diciembre de 2009 y abril de 2010. Solo se incluyerion pacientes con ginecomastia (diámetro >0,5cm). Los datos clínicos y antropométricos se recogieron en la historia clínica del adolescente. El impacto emocinal se valoró a través de un cuestionario con preguntas semiabiertas, diseñadas para tal motivo. Resultados: Se diagnosticaron 21 casos; se incluyeron 19 de ellos. La prevalencia fue de 2,66%. Ni las enfermedades padecidas ni las medicaciones recibidas estuvieron asociadas con ginecomastia. No se detectó consumo significativo de drogas de abuso. En base al impacto emocional, se identificaron dos grupos: uno indiferente ante la ginecomastia y otro con afectación emocional descripto como indiferencia/enojo. Conclusiones: La ginecomastia es un hecho esperable en el desarrollo puberal de los adolescentes varones, sin embargo, en muchas oasiones, genera un impacto emocional que puede condicionar la relación con pares y la integración social de los chicos que la presentan. Aunque el grupo estudiado es pequeño, en la mitad de los pacientes con afectación emocional, la ginecomastia no había sido motivo de consulta. El diagnóstico efectuado por el médico, habilitó a los adolescentes a poder expresar su malestar y a manifestar dudas e inquietudes. Destacamos la importancia dela consulta con visión integral, en un ámbito de privacidad y confidencialidad en la atención de adolescentes. Es una oportunidad única para realizar exámen físico completo y una semiología ampliada que incluya los aspectos emocionales, familiares y sociales que contribuyen a la calidad de vida de los jóvenes que atendemos

Adolescentes de hoy... ¿Mitos de ayer? / Today´s teens, yesterday´s myths?

Introducción: El conocimiento sobre la sexualidad juvenil es un tema ineludible en la atención de adolescentes. Las distintas culturas y costumbres poseen mitos que muchas veces tienen un peso mayor a la información brindada por el médico y pueden dificultar un efectivo abordaje. Si estas creencias son erróneas, se pueden transformar en un factor de riesgo para contraer infecciones de transmisión sexual (ITS/HIV) y embarazos no buscados. Objetivos: 1)conocer los mitos sobre aspectos de la sexualidad en adolescentes que consultaron en servicios especializados. 2)inferir si existe relación entre los mitos y la edad, edad de inicio de relaciones sexuales (IRS), procedencia y grado de instrucción. 3)indentificar los conocimientos que representan mayor riesgo en relación a la salud sexual y reproductiva. 4)comparar resultados entre las poblaciones estudiadas. Metodología: Estudio descriptivo, transversal, en base a una encuesta autoadministrada, voluntaria de 28 preguntas. Se seleccionaron mitos y conocimientos erróneos sobre métodos anticonceptivos (MAC), ITS/HIV, menstruación y sexualidad que se detectan en las consultas. Se realizó a 111 adolescentes mujeres, con inicio de relaciones sexuales (IRS), que concurrieron al Servicio de Ginecología Infantojuvenil del Hospital Pirovano (HP) y al de Adolescencia del Hospital de Niños Ricardo Gutiérrez (HNRG), entre marzo y abril de 2010. Resultados: La edad media de inicio de relaciones sexuales fue de 15,5 años. El 19% eran extranjeras. Todas estaban alfabetizadas. Según nacionalidad hubo diferencias estadísticamente significativas en el porcentaje de preguntas correctas. Las pacientes con secundario incompleto o en curso respondieron correctamente 60% de las preguntas y las que completaron el secundario 73%. Conclusiones: Ciertos mitos continúan vigentes entre los jóvenes, aún teniendo acceso a sistemas de salud y educación . Por eso ratificamos la necesidad de conocer estos aspectos para tenerlos en cuenta en nuestra práctica diaria , no juzgar ni prejuzgar, sino generar un espacio amigable, de confidencialidad, privacidad y confianza para poder abordar mejor estos temas, evacuar dudas, e intentar así desmitificar la sexualidad