Anti-gastric parietal cell antibodies for autoimmune gastritis screening in juvenile autoimmune thyroid disease.

OBJECTIVE: Patients with autoimmune thyroid disease (ATD) have a higher prevalence of autoimmune gastritis (AIG) compared with the general population. The association between ATD and AIG is poorly characterized in the pediatric age. We reviewed the prevalence of anti-gastric parietal cell antibodies (PCA) in young patients with ATD to evaluate its usefulness as a marker for AIG screening. METHODS: We evaluated 220 children and adolescents (11.28 ± 6.37 years) with ATD (186 with autoimmune thyroiditis (AT) and 34 with Graves' disease (GD). At ATD diagnosis and annually thereafter, blood counts and PCA levels were measured. In patients positive for PCA, plasma gastrin, chromogranin A, vitamin B12, iron and ferritin levels and H. pylori antigen were measured. PCA-positive patients > 18 years were invited to undergo a gastroscopic exam. RESULTS: PCA positivity was detected in ten (4.5%) subjects (5F/5M; 12.6 ± 3.4 years). The prevalence of PCA positivity was not significantly different in the comparison of GD and AT patients (p = 0.9). PCA positivity was detected after 2.7 ± 2.7 years of follow-up in AT and 4.4 ± 4.0 years in GD (p = 0.4). Autoantibody positivity was more prevalent in female patients, in both AT and GD (p = 0.02 and p = 0.03, respectively). At detection of PCA positivity, five out of ten PCA-positive patients had iron deficiency, four vitamin B12 deficiency, two anemia, three hypergastrinemia and two elevated chromogranin values. Two patients had H. pylori infection. Gastroscopy was performed in the five ATD patients and in all patients, AIG was confirmed. CONCLUSION: In the juvenile population, ATD and AIG may also be associated. PCA screening is useful to detect subjects at risk for this condition. Due to the longer life expectancy of the pediatric population and considering the relatively high risk of malignant transformation, early surveillance monitoring is mandatory for children and adolescents with ATD.

Analysis of prognostic factors in COVID-19 hospitalized patients: an Italian single-center case-control study.

OBJECTIVE: COVID-19 clinical presentation ranges from asymptomatic infection to an inflammatory cytokine storm with multi-organ failure and fatal outcomes. The identification of high-risk patients for severe disease is crucial to plan an early treatment and intensive follow-up. We aimed to investigate negative prognostic factors in a group of patients hospitalized for COVID-19. PATIENTS AND METHODS: 181 patients (90 men and 91 women, mean age 66.56 ± 13.53 years) were enrolled. Each patient received a work-up including medical history, clinical examination, arterial blood gas analysis, laboratory blood tests, feasible ventilatory support required during hospital stay, intensive care setting required, duration of illness and length of hospital stay (>or<25 days). For the assessment of the severity of COVID-19, three main indicators were considered: 1) the intensive care unit (ICU) admission 2) the hospitalization length >25 days; 3) the need of non-invasive ventilation (NIV). RESULTS: The independent risk factor associated with the ICU admission were lactic dehydrogenase elevation (p=0.046), C reactive protein elevation (p=0.014) at hospital admission and direct oral anticoagulant home therapy (p=0.048); for hospital length >25 days: early corticosteroid therapy (p=0.035); for NIV treatment: ferritin elevation at hospital admission (p=0.006). CONCLUSIONS: The presence of the above factors may be useful to identify patients at high risk of developing a severe COVID-19 that need an early treatment and intensive follow-up.

[Evaluation of the working load in subjects using equipment fitted with VDU]. / Valutazione del carico lavorativo in soggetti che utilizzano apparecchiature munite di videoterminali.

In Italy the health and safety of VDU workers is regulated by section VI of Legislative Decree 626/94 (with later modifications). In compliance with this law, employers shall be obliged to analyse workstations, assess and reduce risks; they shall also identify any worker who habitually uses display screen equipment as significant part of his normal work (20 hours per week). Our study presents a new method, named WODSE (Workers of Display Set Equipment), for the objective evaluation of VDU workers effort. It is a software created for measurement of VDT usage time, able to calculate weekly use for each worker. We applied this method to tellers of a great national services agency, obtaining an improvement of VDU risk assessment and, consequently, management.

[Evaluation and risk management of the risk of robbery]. / Valutazione e gestione del rischio rapina.

The carried out work have permitted to make a technical evaluation of the risk robbery in a big Company of services and to formulate a strategy in order to prevent the criminal event and its effects on the workers' health. At this point an algorithm of prevision of risk has been formulated, taking account the elements of probability of criminal act and those ones referring to the relating damage according to the following formula: RISK(R) = PROBABILITY(P) x DAMAGE(D). The use of this method has proved useful to obtain the right evaluation risk robbery and it has permitted to elaborate a document of Health Protection to use towards the workers who are involved in the event with the active participation of the Company doctor.

[Health surveillance in health care workers]. / La sorveglianza sanitaria degli operatori sanitari: esperienza in un Policlinico universitario.

In a complex reality as the hospital, occupational physician plays a key role in risk prevention through health surveillance. The medical examination is intended to highlight any possible deterioration of workers' health and to detect workers' hypersusceptibility to occupational hazards. We report biostatistic data resulted from health surveillance conducted on health care workers in 2005 and 2006 in a universitary hospital, with particular regard to the judgement of the fitness to work and the reasons that has determined it. Our report, in agreement with data available in literature, shows that manual patient lifting is one of the most common professional hazards within the hospital and occupational physician must pay a special attention to it, promoting an integrated answer.

[Biomechanical risk assessment of manual material handling in vegetables and fruit departments of supermarkets]. / Valutazione del rischio da movimentazione manuale dei carichi nel reparto ortofrutta in un esercizio commerciale di medie dimensioni.

There is little in the literature about the risks of manual handling of material in supermarkets and what there is refers solely to storehouse work. This contrasts with the substantial number of studies of the risk of repeated arm movements among supermarket cash-desk staff. The scarcity of information is partly due to the difficulties of applying widely employed, standardized evaluation methods in this sector. One of the conditions limiting the application of the NIOSH protocol in this retail sector is that lifting tasks are so often closely tied to transport. The biomechanical analysis method we used brought to light considerable risks in many of the steps investigated: unpacking the pallet, unloading the crates from the pallet to the ground, lifting them from the floor onto display stands, and filling the boxes on the stands with goods before the shop opens. Images acquired on site were analyzed in the laboratory. We selected the most indicative images, which were then studied as regards posture and biomechanics using Apalys 3.0 software (ILMCAD GmbH, Ilmenau, Germany). Biomechemical analysis was done on the following movements: unloading crates from the pallet, positioning them on fruit and vegetable department display stands, and filling the boxes on the stands. We obtained a prediction of 2720 to 5472 N for the load at the lumbosacral junction (L5-S1). Simulation of the NIOSH index gave a value of 2.69 in the only case where the Waters protocol could be applied.

[Role of the occupational health physician in the evaluation of biological risk and cancer in a hospital setting]. / Ruolo del medico competente nella valutazione del rapporto tra rischio biologico e cancro in ambiente sanitario.

OBJECTIVE: Elaborating and proposing a model of behaviour which is useful for any occupational doctor of a hospital in the management of the people exposed to biological risk, with the aim of preventing or early diagnosing neoplasias caused by cancerogenic infective agents. MATERIALS AND METHODS: This study was conducted analyzing the literature data regarding biohazard work accidents which happened in health environment and the scientific evidence of the causal relationship between infective agents and development of neoplasias. RESULTS: Data in literature show that the biohazard work accidents are very numerous and there is high percentage of sub-communication of them; many infective agents that the health workers can get in contact with, after biohazard biological accidents, are cancerogenic: HBV, HCV, HIV, HP belong to group 1 of IARC classification. CONCLUSION: Health workers exposed to biological risk and in particular those who got in contact with infective biological liquids can be considered at risk of neoplasia development; for this reason, we propose a three phases behaviour model: 1. Biological risk accidents prevention; 2. Prevention of infective disease after an accident; 3. Neoplasia prevention and/or early diagnosis after the development of the infective disease.

Pro-sequence assisted folding and disulfide bond formation of human nerve growth factor.

Nerve growth factor (NGF) is a member of the neurotrophin family. These growth factors support neuronal survival and differentiation. Neurotrophins are synthesized as pre-pro-proteins. Whereas the pre-sequences mediate secretion, the function of the pro-peptides is largely unknown. To test the role of the pro-sequence as a folding enhancer, recombinant human pro-NGF (rh-pro-NGF) was produced in Escherichia coli. The oxidative refolding of rh-pro-NGF and rh-NGF was studied using electrospray mass spectrometry (ESIMS) time-course analysis. This analysis permitted both the identification and quantification of intermediates present during the process. The disulfide bonds formed at different times of the refolding processes were characterized by proteolytic digestion followed by matrix assisted laser desorption ionization mass spectrometry (MALDIMS) analysis. Folding yields and kinetics of rh-pro-NGF were significantly enhanced when compared to the in vitro refolding of mature rh-NGF. These results suggest that the pro-sequence of NGF promotes folding of the mature part.

Early intermediates in the PDI-assisted folding of ribonuclease A.

The oxidative refolding of ribonuclease A has been investigated in several experimental conditions using a variety of redox systems. All these studies agree that the formation of disulfide bonds during the process occurs through a nonrandom mechanism with a preferential coupling of certain cysteine residues. We have previously demonstrated that in the presence of glutathione the refolding process occurs through the reiteration of two sequential reactions: a mixed disulfide with glutathione is produced first which evolves to form an intramolecular S-S bond. In the same experimental conditions, protein disulfide isomerase (PDI) was shown to catalyze formation and reduction of mixed disulfides with glutathione as well as formation of intramolecular S-S bonds. This paper reports the structural characterization of the one-disulfide intermediate population during the oxidative refolding of Ribonuclease A under the presence of PDI and glutathione with the aim of defining the role of the enzyme at the early stages of the reaction. The one-disulfide intermediate population occurring at the early stages of both the uncatalyzed and the PDI-catalyzed refolding was purified and structurally characterized by proteolytic digestion followed by MALDI-MS and LC/ESIMS analyses. In the uncatalyzed refolding, a total of 12 disulfide bonds out of the 28 theoretical possible cysteine couplings was observed, confirming a nonrandom distribution of native and nonnative disulfide bonds. Under the presence of PDI, only two additional nonnative disulfides were detected. Semiquantitative LC/ESIMS analysis of the distribution of the S-S bridged peptides showed that the most abundant species were equally populated in both the uncatalyzed and the catalyzed process. This paper shows the first structural characterization of the one-disulfide intermediate population formed transiently during the refolding of ribonuclease A in quasi-physiological conditions that mimic those present in the ER lumen. At the early stages of the process, three of the four native disulfides are detected, whereas the Cys26-Cys84 pairing is absent. Most of the nonnative disulfide bonds identified are formed by nearest-neighboring cysteines. The presence of PDI does not significantly alter the distribution of S-S bonds, suggesting that the ensemble of single-disulfide species is formed under thermodynamic control.

Blood lead concentration and biological effects in workers exposed to very low lead levels.

A longitudinal study was carried out on two groups of workers engaged in tin/lead alloy welding in the telecommunication sector. The risk of exposure was evaluated by measuring levels of airborne lead (PbA) and the amount of lead absorbed (PbB). The-correlated effects were assessed by determining zinc protoporphyrin (ZPP) and hemoglobin levels (Hb) and red blood cell (RBC) count. We also recorded subjective symptoms reported by workers. One group of welders composed of 365 subjects underwent two monitoring sessions performed in 1991 and 1995, respectively (Group A). A second group of welders (whose number fluctuated between 148 and 247 subjects) underwent yearly testing for 7 consecutive years (1988-1994; Group B). Results indicated a very low risk of lead exposure during microwelding operations (PbA range, 1.5-24 micrograms/m3). In fact, blood concentrations of Pb (range, 5-55, micrograms/dL) among both groups of welders were significantly higher than those in the general population in Rome (PbB range, 5-16 micrograms/dL); nevertheless, they were significantly lower than the Occupational Safety and Health Administration's permissible exposure limits ZPP determined only in Group B of welders ranged from 5 to 16 micrograms/dL (median, 22 micrograms/dL). No variation was found in the other biological parameters investigated, and no health effects were observed. During the study period, the introduction of some technological innovations led to a further reduction in Pb exposure and, subsequently, to its total elimination. PbB concentrations gradually declined to lower values (6-36 micrograms/dL), and it was interesting to note that ZPP concentrations also decreased to normal levels (range, 2-47 micrograms/dL; median, 11 micrograms/dL), demonstrating that the effect of lead on heme synthesis may occur even at very low levels of Pb exposure.

Occupational exposure to chromium--an assessment of environmental pollution levels and biological monitoring of exposed workers.

In an aircraft construction factory where adhesives containing Cr(VI) compounds were used, the risk of chromium exposure was studied by assessing airborne chromium levels and urinary levels of chromium excretion. Chromium exposure was evaluated by personal sampling over a period of 4 hr in a group of 16 occupational workers selected from a group of 55. Chromium absorption was determined by collecting urine samples from all subjects (n = 55) at 3 different times: prior to the work-shift at the beginning of the working week and prior to and after the workshift at the end of the working week. Each urine sample was tested for chromium and creatinine concentration. Results showed very low exposure to airborne chromium, since values obtained (0.02-1.5 micrograms/m3, GM: 0.17, GSD: 5.34 micrograms/m3) were significantly lower than the ACGIH Hygiene Standard (50 micrograms/m3). Likewise, urinary chromium excretion (0.16-7.74 micrograms/g creat.) was higher than excretion in the general population (0.07-0.17 microgram/g creat.) but lower than BEI-ACGIH (30 micrograms/g creat.). The greatest difference between excretion levels measured before and after the workshift was 2.44 micrograms/g creat, i.e. 4 times lower than the difference proposed by ACGIH (10 micrograms/g creat.).

[Presentation forms of occupational psychologic disorders: experience at a national-level call center]. / Forme di presentazione del disagio psicologico a genesi occupazionale: esperienza presso il call center di una azienda di rilevanza nazionale.

Often in Occupational Medicine doctors misunderstand or underestimate the occupational psychologic discomfort forms deriving from "transverse risks" of organizational kind. In this communication is shortly described a our study with in a "call center". We explain the several kinds of psychologic discomfort which we have here recognized and studied. We show, at last, some of job's organization modifications rose from the first outcome of our study.

Occupational risk factors for the sporadic form of Creutzfeldt-Jakob disease.

Some case reports among European farmers and a few case-control studies suggested the hypothesis of an increased risk of the sporadic form of CJD (sCJD) associated with livestock farming or work as a butcher. Also, the discovery of the possibility of transmission of the disease via blood or by contact following corneal or dura madre transplant suggested that health occupations might also run higher sCJD risks. However, a meta-analysis of three case-control studies and a multicentre European study did not find any positive association between sCJD and health-related jobs or occupational contact with livestock, such as cattle and sheep, or animal products. To explore possible occupational risk factors for Creutzfeldt-Jakob disease (CJD), we used a publicly available US database including about 6 million deaths in 24 states during 1984-95. Cases were 636 deaths (300 men and 336 women) with CJD (ICD-9 code 046.1) as the underlying cause of death. Controls were 3,180 deaths randomly selected from among those who died from all other diseases except those affecting the central nervous system. CJD cases represented a wide variety of occupations (159) and industries (147). Among occupations and industries, for which previous reports suggested potential exposure to a transmissible spongiform encephalopathy (TSE) agent, the OR for CJD was significantly increased among butchers (OR = 6.8, 95% C.I. 1.5, 30.1, based on 4 cases and 3 controls), and persons working in offices of physicians (OR = 4.6, 95% C.I. 1.2, 17.6 based on 5 cases and 4 controls). Nine other occupations and seven other industries, for which no previous suggestion existed in the literature, also showed significant associations. Overall, our results suggest that occupational exposures are not an important source of sCJD infection. However, as the excess among butchers and some workers in health occupations was consistent with previous reports, more indepth research is warranted to address the hypothesis.

[Health promotion in the occupational setting: what are the prospects in the Italian situation?]. / La promozione della salute in ambiente di lavoro: quali prospettive nella situazione italiana?

Over the past decades advances in sciences and medicine have improved living and health conditions and lengthened life expectancy. These benefits are associated with an increase in prevalence of chronic degenerative diseases. With their multi-factorial aetiology these diseases are influenced by life styles and personal habits and require prolonged medical care and high social costs. Now days health is no longer considered as the absence of disease but a state of mental, physical and social well-being. The World Health Organization has defined health promotion as "the process of enabling people to increase control over and to improve health". Since the 70s in the USA many health promotion programmes have been proposed, especially by large corporations, in order to ensure a more efficient, productive and motivated work-force, to reduce health insurance costs and to provide a better company image. Workplaces,--particularly when the working population is relatively stable--are excellent areas for health promotion programmes because workers can be monitored over a long period of time. The most successful programmes are aimed at modifying behaviour in risk patterns (smoking, alcohol abuse, eating disorders, etc.) through information, active participation, screening, follow-up, personalized programmes, changes in the working environment, physical exercise programmes. These health promotion programmes are extremely hard to develop for Italian workers. Most firms are small or very small and much still remains to be done to eliminate well-known occupational risk factors. The current flexibility of modern work patterns could constitute a further obstacle.

[Effect of treatment with selective serotonin reuptake inhibitors on lipid profile: state of the art]. / Effetto del trattamento con inibitori selettivi del reuptake della serotonina sul profilo lipidico: stato dell'arte.

Selective Serotonin Reuptake Inhibitors (SSRI) are an effective treatment for depressive disorder. Nevertheless, there is evidence suggesting a negative effect of these drugs on the lipid profile of the patients. We carried out a systematic review of the literature evaluating the influence of therapy with SSRI on lipid profile. Data source was MEDLINE. Clinical trials, prospective studies, retrospective studies and reviews published until November 2011 were considered. We identified twelve studies published from 1994 to 2011, of which four were randomized clinical trials, six were prospective studies and two were retrospective studies. Sertraline and Paroxetine seemed to have negative effects on the serum levels of Total and LDL Cholesterol. Citalopram did not demonstrate any influence on Total and LDL Cholesterol blood levels, being conversely associated with a slight increase of the HDL Cholesterol levels. Few data were found about the effects of Fluoxetina e Fluvoxamina on lipid profile and no data were found about Escitalopram. Sertaline and Paroxetine, two effective and widely used drugs for the treatment of major depression, seem to have a negative effect on the lipid profile; Citalopram, with its neutral or positive effect on lipid profile, should be considered the treatment of choice for depressive patients affected by dyslipidemia.