The real-world safety profile of tirzepatide: pharmacovigilance analysis of the FDA Adverse Event Reporting System (FAERS) database.

PURPOSE: Randomized controlled trials with tirzepatide (TZP) displayed unprecedented glucose and body weight lowering efficacy in individuals with type 2 diabetes and/or obesity and a safety profile similar to that of glucagon-like peptide-1 receptor agonists (GLP-1RA), mainly characterized by gastrointestinal (GI) adverse events (AE). Concerns on diabetic retinopathy, pancreato-biliary disorders, and medullary thyroid cancer were also addressed. We aimed to investigate whether the same safety issues emerged from the FDA Adverse Event Reporting System (FAERS) post-marketing surveillance database. METHODS: OpenVigil 2.1-MedDRA-v24 and AERSMine (data 2004Q1-2023Q3) were used to query the FAERS database. Reports of GI AE, diabetic retinopathy, pancreato-biliary disorders, and medullary thyroid cancer were investigated. The analysis was then filtered for age, gender, and designation as primary suspect. AE occurrence with TZP was compared to insulin, sodium-glucose cotransporter-2 inhibitors, metformin, and GLP-1RA. RESULTS: Disproportionate reporting of GI [i.e., nausea (ROR 4.01, 95% CI 3.85-4.19)] and pancreato-biliary disorders [i.e., pancreatitis (ROR 3.63, 95% CI 3.15-4.19)], diabetic retinopathy (ROR 4.14, 95% CI 2.34-7.30), and medullary thyroid cancer (ROR 13.67, 95% CI 4.35-42.96) was detected. TZP exhibited a similar risk of GI AE and medullary thyroid cancer and a lower risk of most pancreato-biliary AE and diabetic retinopathy vs. GLP-1RA. CONCLUSIONS: TZP was associated with an increased risk of specific AE. However, its safety profile was similar to that of GLP-1RA, without increased risk of pancreato-biliary AE, diabetic retinopathy, and medullary thyroid cancer.

Workplace violence among healthcare workers, a multicenter study in Italy.

OBJECTIVES: The purpose of this study is to assess the prevalence and determinants of workplace violence and the sociodemographic risk factors associated. STUDY DESIGN: This was a multicenter cross-sectional study. METHODS: The study was performed using self-compiled Italian version of the World Health Organization's questionnaire on workplace violence online by filling in a Google form. The survey was opened from May 2018 to March 2020 and lasted 5-10 min. RESULTS: The sample consists of 3659 healthcare workers, of which 2525 (69%) are females, 1446 (39.5%) are nurses, and 2029 (55.5%) are health workers from northern Italy. The most frequent age group of the sample is 50-54 years (16.7%). A total of 366 (10%) healthcare workers are victims of physical aggression at work in the last 12 months, of which 6.3% with a weapon. The risk of being a victim of physical aggression at work in the last 12 months is significantly associated with the following independent variables: male gender (odds ratio [OR] 1.72, 95% confidence interval [CI]: 1.36-2.17), work in southern Italy (OR 1.59, 95% CI: 1.10-2.28), and being a nurse (OR 2.56, 95% CI: 2.01-3.25). The risk of being a victim of physical aggression at work with a weapon in the last 12 months is significantly associated with work in southern Italy (OR 9.33, 95% CI: 3.83-22.73). A total of 1723 (47.1%) of healthcare workers declare to be a victim of verbal aggression at work in the last 12 months. The risk of being a victim of verbal aggression at work in the last 12 months is significantly associated with the following independent variables: work in northern Italy (adjusted OR [aOR] 1.54, 95% CI: 1.32-1.81), work in southern Italy (aOR 3.68, 95% CI: 2.90-4.68), and be more than 55 years old (aOR 0.73, 95% CI: 0.63-0.85). CONCLUSIONS: The study underlines that the problem of verbal and physical aggression against healthcare workers is still central and is a further starting point for research. The prevalence of violence is difficult to assess because violent incidents are underreported or unreported. The results of the study suggest that increased awareness is needed to develop effective control strategies at the individual, hospital, and national levels to prevent aggression and improve the conditions of victims.

Corn protein-based thermoplastic resins: effect of some polar and amphiphilic plasticizers.

Homogeneous blends of corn gluten meal (CGM) and "polar" plasticizers (water, glycerol) or "amphiphilic" plasticizers [octanoic and palmitic acids, dibutyl tartrate and phthalate, and diacetyl tartaric acid ester of mono-diglycerides (DATEM)] were obtained by a hot-mixing procedure. The glass transition temperature (T(g)) of the blends was measured by modulated differential scanning calorimetry and dynamic mechanical thermal analysis, as a function of plasticizer type and content (0-30%, dwb). The plasticizing efficiency (i.e., decrease of T(g)) at equal molar content was found to be proportional to the molecular weight and inversely proportional to the percent of hydrophilic groups of the plasticizer. The migration rate of the plasticizers in the polymer was related to their physicochemical characteristics. It was assumed that polar substances interacted with readily accessible polar amino acids, whereas amphiphilic ones interacted with nonpolar zones, which are buried and accessible with difficulty. The temperature at which a thermoplastic resin of plasticized CGM could be formed was closely connected to the T(g) of the blend.

Thermal properties of corn gluten meal and its proteic components.

Thermal properties of corn gluten meal (CGM) and of its extracted proteic components (zein and glutelin) at 0% moisture content, is studied by dynamic mechanical thermal analysis (DMTA) and modulated differential scanning calorimetry (MDSC). The glass transition temperature (Tg) on first heating, is measured at 176 and 174 degrees C, respectively, for hot-air-dried and native CGM. For zein and glutelin isolated fractions, the measured Tg values are 164 and 209 degrees C, respectively. The calculated Tg from using Matveev's method (Matveev YI. Spec Publ R Soc Chem 1995;156;552) is in good agreement with experimental data for zein, a well defined protein. MDSC allows the measurement of change in heat capacity at Tg (deltaCp) with a single heating scan, avoiding sample alteration, and deltaCp values are 0.365 J/g per K for zein and 0.184 J/g per K for glutelin. The differences observed in Tg, relaxation temperatures, deltaCp and tan delta peak height are related to differences in the structure of the proteins, through the cross-linkages and hydrogen or van der Waals interactions. Experimental data from DMTA and MDSC, and the Couchman-Karasz thermodynamic approach indicate that CGM behaves as a miscible blend of its components, with high non-polar interactions between zein and glutelin proteins.

Expression of the chemokine receptor CCR3 on human mast cells.

BACKGROUND: The aim of this study was to investigate whether human mast cells express functional active CCR3 receptors, which are activated by CC chemokines. These ligands include the CCR3-selective chemokines eotaxin and eotaxin-2 and the more promiscuous CC chemokines, MCP-4, MCP-3, MCP-2 and RANTES. METHODS: Immunohistochemical analysis was performed on skin, gut and lung specimens. Double immunostaining was performed with anti-CCR3 and antitryptase, and anti-CCR3 and antichymase antibody (Ab) by using the avidin-biotin-peroxidase system with two different substrates. Mast cells were isolated and purified from human lung parenchyma (HLMC) by countercurrent elutriation followed by discontinuous Percoll density gradient. Flow-cytometric analysis of HLMC surface CCR3 expression was performed with the monoclonal Ab anti-CCR3 (7B11). Functional activation of HLMC was verified by the ability of cells to release histamine and/or migrate in response to eotaxin. RESULTS: High percentages (>70%) of tryptase-positive cells showing CCR3 expression were found in the skin and in the intestinal submucosa, whereas much lower percentages (< or = 20%) were found in the intestinal mucosa and in the lung interstitium. Eotaxin (1-100 nM) neither induced histamine release from HLMC nor enhanced anti-IgE-induced histamine release. In contrast, eotaxin (10-100 nM) and RANTES (10-100 nM) induced HLMC chemotaxis in vitro. Preincubation of HLMC with antibody anti-CCR3 (5 microg/ml) before loading into the chemotaxis chamber abrogated chemotaxis elicited by eotaxin. Double immunostaining with anti-CCR3 and anti-chymase antibody showed that the vast majority of CCR3-expressing mast cells in the various human tissues examined were tryptase-chymase double-positive. CONCLUSIONS: These results indicate that CCR3 is expressed on human mast cells and that these cells are attracted by CCR3-binding chemokines.

Tat protein is an HIV-1-encoded beta-chemokine homolog that promotes migration and up-regulates CCR3 expression on human Fc epsilon RI+ cells.

Human basophils and mast cells express the chemokine receptor CCR3, which binds the chemokines eotaxin and RANTES. HIV-1 Tat protein is a potent chemoattractant for basophils and lung mast cells obtained from healthy individuals seronegative for Abs to HIV-1 and HIV-2. Tat protein induced a rapid and transient Ca(2+) influx in basophils and mast cells, analogous to beta-chemokines. Tat protein neither induced histamine release from human basophils and mast cells nor increased IL-3-stimulated histamine secretion from basophils. The chemotactic activity of Tat protein was blocked by preincubation of FcepsilonRI(+) cells with anti-CCR3 Ab. Preincubation of Tat with a mAb anti-Tat (aa 1-86) blocked the migration induced by Tat. In contrast, a mAb specific for the basic region (aa 46-60) did not inhibit the chemotactic effect of Tat protein. Tat protein or eotaxin desensitized basophils to a subsequent challenge with the autologous or the heterologous stimulus. Preincubation of basophils with Tat protein up-regulated the level of CCR3 mRNA and the surface expression of the CCR3 receptor. Tat protein is the first identified HIV-1-encoded beta-chemokine homologue that influences the directional migration of human FcepsilonRI(+) cells and the expression of surface receptor CCR3 on these cells.