Mercury Vapour Long-Lasting Exposure: Lymphocyte Muscarinic Receptors as Neurochemical Markers of Accidental Intoxication.

Introduction. Chronic poisoning may result in home setting after mercury (Hg) vapours inhalation from damaged devices. We report a chronic, nonoccupational Hg poisoning due to 10-year indoor exposure to mercury spillage. Case Report. A 72-year-old man with polyneuropathy of suspected toxic origin. At hospitalization, toxicological clinical evaluations confirmed the altered neurological picture documented across the last decade. Periodic blood and urine Hg levels (BHg, UHg) monitoring were performed from admission (t0), until 1 year later (t2), paralleled by blood neurochemical markers assessment, that is, lymphocytes muscarinic receptors (l-MRs). At t0: BHg and UHg were 27 and 1.4 microg/L, respectively (normal values: BHg 1-4.5; UHg 0.1-4.5), associated with l-MRs increase, 185.82 femtomoL/million lymphocytes (normal range: 8.0-16.0). At t1 (two days after DMSA-mobilization test), BHg weak reduction, paralleled by UHg 3.7-fold increase, was measured together with further l-MRs enhancement (205.43 femtomoL/million lymphocytes). At t2 (eight months after two cycles of DMSA chelating therapy ending), gradual improving of clinical manifestations was accompanied by progressive decrease of BHg and UHg (4.0 and 2.8 microg/L, resp.) and peripheral l-MRs neurochemical marker (24.89 femtomoL/million lymphocytes). Conclusion. l-MRs modulatory effect supports their use as peripheral neurochemical marker in Hg poisoning diagnosis and chelation therapy monitoring.

Evaluation of use of antibiotics without prescription among young adults in Albania case study: Tirana and Fier District.

BACKGROUND: Self-medication is defined as the utilization of drugs to treat self-diagnosed disorders or symptoms, or the irregular or continuous use of a prescribed drug for chronic or repeated diseases or symptoms. The main problem with self-medication with antimicrobials is the emergence of pathogenic resistance. Antimicrobial resistance is an existing problem world-wide, mainly in developing countries. The aims and objectives of the study presented in this article are to evaluate the prevalence of purchase of antibiotics without prescription and appropriateness of use among adults and to determine the impact of the education level on the sensibility level over the use of antibiotics. METHODS: This was a questionnaire based study of 3 month duration. The study includes data from 350 young adults (182 men/172 women, mean age ± SD: 34.72 ± 13.7 years), who visited ten different pharmacies located in the city of Tirana and the "Olympus" Private Medical Clinic in Fier between December 2012 and March 2013. Also a part of questionnaires was distributed by e-mail. RESULTS: The results of this study showed that out of 350 young adults, 273 (78.14%) of them used antibiotics as self medication. The most common reasons for self administration of antibiotics were fever 171 (29.23%), sore throat 170 (29.06%) and cough 83 (14.19%). In this study we observed that the most common source of information regarding self-medication is the pharmacy (community pharmacists) 166 (36.40%) and most common antibiotic used as self-medication is amoxicillin 70 (19.39%). Authors also determined the impact of education level over the use of antibiotics. The results showed that adults with low and medium education level (7.986% and 43.056% respectively) were most likely to use antibiotics as self-medication. CONCLUSIONS: The findings from this study highlight the striking prevalence of self-medication among young adults in Albania and the lack of awareness about the risks associating their use. We recommend that a holistic approach must be taken to prevent this problem from escalating which would involve awareness and education regarding the implications of self medication, strategies to prevent the supply of medicines without prescription by pharmacies and strict rules regarding pharmaceutical advertising.Hippokratia 2014; 18 (3): 217-220.

Defining reference values of trace elements in the tear film: diagnostic methods and possible applications.

The study has been performed on tears of apparently healthy subjects who live and work in urban and rural areas, respectively. After the collection the following elements were investigated: chromium (Cr); arsenic (As); copper (Cu); zinc (Zn); selenium (Se); rubidium (Rb); barium (Ba); lead (Pb) and cobalt (Co). Significantly higher values of As were found in subjects living and working in rural areas as compared to those found in urban area residents (0.290 vs. 0.025; p<0.001). Conversely, Ba and Pb were significantly lower in rural area residents (1.10 vs. 2.50, p=0.027 and 1.70 vs. 1.10, p=0.057, respectively). Our data show that trace elements analysis in tears is possible; further studies could define if it could be a reliable biomarker in persons exposed to high concentration of trace elements due to working or environmental reasons.

[Efficacy and appropriateness in updating and validating the activities of the occupational health physician]. / Strumenti di aggiornamento ed orientamento delle attività del medico del lavoro, efficacia ed appropriatezza.

BACKGROUND: We reviewed the Italian tools for updating and validating the activities of occupational health physicians (guidelines, consensus documents, technology assessment, good practices, etc.) from the point of view of efficacy and appropriateness. RESULTS AND CONCLUSIONS: We examined more than 20 guidelines produced since 2003 by the Italian Society of Occupational Health and Industrial Hygiene (SIMLII), the procedures issued by the National System of Guidelines in Medicine/SNLG) by the Italian National Health Institute (ISS) and the new law on occupational safety and health "Decreto Legislativo 81/08", which for the first time includes and defines in specific legislation the different possible instruments for guiding the activities of the occupational health physician, not only to improve the effectiveness of interventions but also aimed at constantly adopting rigorous methodologies based on evidence.

[Evaluation of the dose of mercury in exposed and control subjects]. / Valutazione delle dosi di mercurio negli esposti e nei controlli.

OBJECTIVES: The aim of this paper was to analyse the concentrations of HgU and HgB in three different groups: 122 workers exposed, 18 workers formerly exposed and 196 subjects not occupationally or environmentally exposed to mercury. METHODS: All the subjects filled out a questionnaire concerning personal data, lifestyle, occupational or non-occupational exposure to Hg and medical history. The amalgam fillings area was measured by a standardised method. RESULTS: Urinary mercury excretion was significantly greater in the group of the exposed workers respect to the group of subjects not occupationally exposed (Median value of 8.3 micrograms/g creatinine and the 5 degrees and 95 degrees percentile respectively of 2.66 e 23.50 micrograms/g creatinine against Median value of 1.2 micrograms/g creatinine and the 5 degrees and 95 degrees percentile respectively of 0.18 and 5.42 micrograms/g creatinine). U-Hg in formerly exposed workers were comparable to U-Hg in non-occupationally exposed subjects, with a median value of 1.6 micrograms/g creatinine. B-Hg values were similar in the three groups: the median value was 3.1 micrograms/l in the non-occupationally exposed, 4.0 micrograms/l in the exposed workers and 3.9 micrograms/l in the past exposed. These value were not significantly different. Among the considered variables (amalgam fillings, fish consumption, age, sex, alcohol intake, chewing-gum and smoking) dental amalgam and fish consumption were significantly related with the Hg urinary excretion and the B-Hg levels. This is particularly true considering the subjects altogether: for the exposed workers, indeed, the occupational exposure was the most relevant variable. CONCLUSIONS: The results of the present research confirmed that the U-Hg excretion in non-occupationally exposed subjects is influenced by amalgam dental fillings. Furthermore, in our study Hg urinary excretion was significantly related with fish consumption. This fact can be explained, according to several recent experimental human and animal trials, considering that methylmercury contained in fish is partially converted, through breakage of the carbon-Hg bond, into Hg inorganic forms, which accumulate in the kidney and have a urinary excretion pathway.

[Musculoskeletal disorders caused by repetitive trauma of the upper limbs: a paradigm of the development of occupational diseases and industrial medicine]. / I "disturbi" muscolo scheletrici da traumi ripetuti agli arti superiori: paradigma della evoluzione delle patologie da lavoro e della Medicina del Lavoro.

The work related musculoskeletal disorders (WMSDs) are a wide range of inflammatory and degenerative disease and disorders that result in pain and functional impairment. All available definitions for WMSDS are non consistent and require in each individual case and in each group study careful identification of symptoms, signs and findings. WMSDs, as a mutifactorial work related disease, are associated to physical and psychosocial factors at work and other individual, sociocultural factors. They are therefore good paradigm for the changing occupational risks and illness and for the new methods that the occupational medicine and the preventive disciplines have to set up. The research and standardization needs appear to be more evident for framing pathogenesis, biological response and pathology of WMSDs and mainly for risk factors assessment, since suitable analytical methods are still not available. The agreement of valid standardised methods (guide lines) for the evaluation of working conditions and assessment of risk factors is required, taking due regard to the multidisciplinary approach both in biological and medical areas and in poly technical ones. Finally attention would be paid to the strategy for prevention, implementing ergonomic programmes, health surveillance, adequate training to work, aimed to primary prevention of WMSDs.

[Reference values in occupational and environmental medicine]. / I valori di riferimento in medicina occupazionale ed ambientale.

Origin, significance, production and use of reference values (RV) in environmental and occupational medicine are discussed. The concept of RV was established in last sixties to correctly interpret data from modern clinical chemistry, but its acceptance in occupational medicine was neither immediate nor easy. These difficulties were mainly due to the nature and biological fate of analytes for which RV were requested, quite different from those of clinical chemistry. For this reason specific procedures to select the subjects, to control the pre analytical factors and to set up analytical methods are necessary. The Italian Society of Reference Values (SIVR) attempted to achieve concepts and practice for RVs and proposed RVs produced by specific investigations for some metals and organic compounds. Furthermore in this paper two provisional lists of RVs for metals and organic substances are proposed. Finally the relationship between RVs and other more familiar guide line values such as action levels and limit values is discussed.

Quality assurance in occupational and environmental laboratory medicine.

In a medical laboratory service, quality assurance (QA) concerns all those actions necessary to provide confidence that the results of laboratory tests will satisfy defined standards for quality. Taking into account the type of testing concerned and the techniques involved, quality assurance will encompass all steps taken to ensure that laboratory results are reliable. It covers the use of scientifically and technically sound practices for laboratory investigations, including selection, collection, transport, identification, storage, preparation and manipulation of specimens and recording, reporting and interpretation of the results. QA refers also to other activities designed to improve the reliability of investigations such as staff training and management, evaluation of the adequacy of the laboratory environment, maintenance and calibration of instruments and the use of technically validated and properly documented methods. All these activities should be described in a quality manual. This document is a prerequisite to obtain certification of the quality system or laboratory accreditation, according to the International Standard ISO 29000 series or the European Standard EN 45001, respectively.

Significance and validity of a shortened lead chelation test.

We evaluated the chelation test in 38 subjects exposed to lead or with suspected lead exposure, comparing the values of lead excretion at the 3rd h (PbU EDTA/3-h) and at the 24th h (PbU EDTA/24-h) after EDTA administration. Good correlation exists between PbU EDTA/3-h and PbU EDTA/24-h (r = .86) and between them and the main biological indicators of dose and effect of lead. When a second chelation test was performed in 15 subjects, a slightly better r coefficient (.93) was observed between the two tests, without reaching statistical significance. It seems difficult, in terms of the type of exposure that we considered, to use the 3-h test, on an individual basis, to predict the PbU EDTA/24-h values.