Workplace health promotion: results of a combined multidisciplinary intervention over a long period - preliminary results.

OBJECTIVE: Obesity is a multifactorial disease that is one of the major public health problems. It is the result of the interaction between behavioral, social and endocrine-metabolic components. Already in the 80s, it was highlighted by the World Health Organization (WHO) that the workplace is an ideal setting for introducing health promotion programs. The aim of the present study was to implement a health promotion program among healthcare workers (HCWs) operating in an Emergency Hospital in Southern Italy, combining diet, sports activity and motivational support over a 24-month period. PATIENTS AND METHODS: Participants were HCWs operating in an Emergency Hospital in Southern Italy. The inclusion criteria were as follows: overweight or obesity, i.e., body mass index (BMI) >25 kg/m2, or waist circumference >102 cm (males), >88 cm (females); dyslipidemia without pharmacological treatment, i.e., total cholesterol >220 mg/dL, or high-density lipoprotein (HDL) cholesterol <35 mg/dL, or low-density lipoprotein cholesterol (LDL) >130 mg/dL, or triglycerides >200 mg/dL; fasting glucose levels >120 mg/dl and/or reduced tolerance to glucose or diabetes mellitus, without pharmacological treatment was determined through HbA1c. RESULTS: The analysis was conducted on 36 participants. Follow-up was performed after twelve (T12) and twenty-four months (T24). The average systolic blood pressure (SBP) and diastolic blood pressure (DBP) values decreased during the time period. The average BMI of both male and female HCWs was significantly reduced from T0 to T12 and from T0 to T24. The triglyceride levels gradually decreased, but not significantly, from T0 to T24. The average blood glucose values decreased from T0 to T12 and from T12 to T24. The number of subjects who started to perform physical activity increased significantly between T0 and T12 and between T0 and T24. CONCLUSIONS: The findings have led to a significant change in HCWs' lifestyles and body perceptions, as well as their ability to work.

Hepatitis C diagnosis and treatment in people who use drugs: mind the gap in the linkage to care.

OBJECTIVE: The objective of this study is to identify a simplified rapid screening and linkage-to-care model for HCV among PWUD. PATIENTS AND METHODS: The study stems from a collaborative project bringing together two local Italian Centers for Drug Addiction and the Hepatology-Infectious Diseases Department of Lazzaro Spallanzani. A research physician analyzed the available medical records seeking to identify HCV and HIV infected patients in care in the addiction centers. Between March 2018 and January 2020 subjects were selected from among a cohort of 720 PWUD in the two Centers' care. The study comprises three steps: first, screening for HCVAb; second, the linkage to care; third, clinical assessment to treatment. The research physician recruited patients for the first two steps directly in their local addiction center. The third step was conducted in the Spallanzani. The characteristics of those subjects who adhered to the three-step study program were then compared to those of the non-adhering PWUD. RESULTS: 194 were known HCVAb positive patients. Of the 505 PWUD in the care of the two Centers eligible for screening, 364 were enrolled in the study. 144 resulted HCVAb positive. 269 were tested for HCVRNA. 101 underwent a full assessment. 96 patients started antiviral therapy with DAA. Patients who refused first step screening were older patients and mainly heroin users; in the second step, almost all the HIV/HCV co-infected patients agreed to a viremia test; in the third step all the HIV/HCV co-infected patients refused HCV treatment. CONCLUSIONS: The study suggests an on-site specialist approach conducted directly in the addiction centers themselves starting from screening; it can bring the goal of HCV PWUD microelimination closer.

Varicella zoster immunity loss in multiple sclerosis patient treated with ocrelizumab.

Ocrelizumab is a novel humanized anti-CD20 antibody used for treatment of relapsing remitting and primary progressive multiple sclerosis with evidence of inflammatory activity. Guidelines suggest assessing vaccination status and eventually vaccinate patients with multiple sclerosis before new disease modifying therapy initiation. However, there are not any specific recommendations about vaccinal immunity reassessment after ocrelizumab injection. We describe the case of a patient who loss varicella zoster vaccinal immunity after the first ocrelizumab infusion. It is advisable to reassess vaccinal immunity to isolate non-immune patients and to adopt suitable preventive measures, including close contacts vaccination and avoidance of contacts with active infection.

Cirrhotic patients are still at risk of developing hepatocellular carcinoma despite Interferon-induced sustained virological response.

INTRODUCTION: Hepatitis C virus (HCV) infection is a common cause of chronic liver disease and hepatocellular carcinoma (HCC). The prevalence of HCC significantly declines among patients achieving a sustained virological response (SVR) after antiviral therapy with pegylated(PEG)-interferon (IFN) and ribavirin. However, up to 5% of patients with SVR may develop HCC. PATIENTS AND METHODS: We investigated the epidemiological, clinical, biochemical and virological characteristics of a small cohort of patients with chronic hepatitis C (CHC) who developed HCC after being successfully treated with PEG-IFN-α and ribavirin. RESULTS: Between September 2000 and January 2003, 598 patients with CHC underwent a complete course of treatment with PEG-IFN-α and ribavirin; 221 out of 598 (37%) patients obtained a SVR. Throughout the 10-year post-treatment follow up, 13 of 221 ( 5.8% ) SVR patients developed HCC. All 13 patients were male and were affected with Child A liver cirrhosis; in addition, at baseline they were significantly older (p < 0.05) and had higher alpha-fetoprotein levels (p < 0.05) in comparison with those who did not develop HCC. Nine patients (69.3%) developed HCC within the first 3 years after antiviral treatment completion, one patient (7.7%) between 3 and 5 years and 3 subjects (23%) between 5 and 10 years; 12 of 13 had a solitary lesion with a mean diameter of 2.5± 0.5 cm. Eleven cases (84.6%) underwent surgical resection, one (7.7%) received liver transplantation, one (7.7%) received palliative care. CONCLUSIONS: The risk of developing HCC after achieving SVR persists in patients with HCV-related cirrhosis. As a consequence, these patients should continue to undergo long-term surveillance for HCC, in order to early detect and treat it.

[Pancreatic harvesting from multiorgan donors for islet transplantation]. / Il prelievo di pancreas da donatore multiorgano per trapianto di insule.

The result of human islet isolation procedures to transplant in type I insulin-dependent diabetic patients is significantly conditioned by the technique used for pancreas procurement from multiorgan donor. In fact, during multiorgan procurement, an improper handling of the gland could result in edema or degranulation of the acinar tissue, detrimental for the islet purification step. The surgical technique used by our surgical team, includes some important refinements to obtain the largest quantity and the best quality of purified endocrine material.

[Drug addiction and hepatitis C: does a correlation exist between the laboratory and clinical pictures?]. / Tossicomania ed epatite C: esiste una correlazione tra laboratorio e clinica?

The prevalence of anti-HCV antibodies reaches 90% positive among intravenous drug addicts. The authors evaluate the possibility of relating laboratory findings to clinical evolution of hepatitis C. Besides, a comparison between first generation anti-HCV system ELISA and the newer RIBA detection system showed no significant difference.

[Prevalence of liver damage in alcoholics and drug addicts]. / Prevalenza del danno epatico in alcol e tossicodipendenti.

The behaviour of drug addicts and alcoholics leads to the cooperation of risk factors concerning the development of chronic hepatitis, liver cirrhosis and hepatocarcinoma. The authors evaluate the prevalence of infections from B, C and Delta virus among a group of 40 intravenous drug users and 40 alcoholics affering to a territorial centre for drug dependence located in Valtellina (Italy). The prevalence of at least one serum marker of virus B, C or Delta hepatitis results to be 85% among drug addicts and 17% among alcoholics. The prevalence of Anti-HCV in alcoholics results to be much lower than found in former works. For what concerns the hepatitis B virus, 68% of the drug addicts and 10% of the alcoholics had at least one positive serum marker. The hepatitis B seronegative patients underwent vaccination with a recombinant-DNA vaccine. Those affected by chronic C hepatitis have been treated with alpha-recombinant interferon. All of the patients underwent health education, psychotherapy and drug-addiction therapy for a period of 8 months. These strategies in prevention and therapy aim to the reduction over the years of the incidence of chronic hepatitis liver cirrhosis and hepatocarcinoma among intravenous drug users and alcoholics.

[The prevention of deep venous thrombosis in patients undergoing an internal arteriovenous fistula intervention]. / Prevenzione di TVP in pazienti sottoposti ad intervento di fistola-arterovenosa interna.

Twenty patients, submitted to internal arteriovenous fistula procedure, were randomly assigned to one of the following treatments: defibrotide 400 mg b.i.d. IM (starting the day before surgery and continuing for the following 7 days); calcium heparin 5,000 IU t.i.d. SC (since the day of surgery and for the following 7 days). No deep venous thrombosis or thrombosis of the fistula were noticed during both treatments and no side effects were observed. In the defibrotide group, ELT showed a significant decrease (-40%) attesting an improvement of fibrinolysis without a plasminogen abatement. These findings indicate that defibrotide represent an effective alternative to calcium heparin for antithrombotic prophylaxis of A-V fistula in uremic patients.