Occurrence of Fipronil in residential house dust in the presence and absence of pets: a hint for a comprehensive toxicological assessment.

The presence of the insecticide Fipronil and its main products of toxicological relevance, namely Sulfone and Desulfinyl, was assessed in 161 residential house dust samples in the absence (N = 101) and presence (N = 60) of cats and dogs in Italy. High-resolution mass spectrometry analysis revealed a significant difference (p < 0.001) in the dust contamination in the presence of pets (median: 467 vs. 24 ng/g dry weight), even if the highest value was found in the absence of pets (82,069 vs. 67,799 ng/g dry weight). Fipronil intake estimates from dust in toddlers, computed according to US-EPA and EU-ECHA guidelines, ranged from 333 to 556 and from 20 to 34 ng/kg per day for acute and chronic scenario, respectively. Dust seemed not able itself to lead to Fipronil overexposure with respect to acute and chronic toxicity health-based guidance values. Kittens were potentially overexposed to Fipronil under both acute (26,076 ng/kg per day) and chronic (1,633 ng/kg per day) scenarios. The mild symptomatology associated with acute intoxication could possibly determine case underreporting within pharmacosurveillance schemes. Its administration was estimated in 7.3-9.7 tons per year. Such a range suggests its prudent use under strict veterinary control to prevent pest resistance and ecotoxicological outcomes.

Polychlorobiphenyl levels in the serum of cats from residential flats in Italy: Role of the indoor environment.

The domestic cat (Felis catus) was used as a sentinel of exposure to polychlorobiphenyls (PCBs) in indoor urban environments y. Sera from 120 cats were pooled to form 30 different groups selected by age (<2 years; > 2 ≤ 8 years; > 8 years), sex, municipality (Bologna and Turin) and environment (indoor vs. outdoor). Test portions of 1 mL were analyzed by means of gas chromatography coupled to high-resolution mass spectrometry (GC-HRMS) for six selected indicators non-dioxin-like PCBs (∑6 PCBs: congeners #28, #52, #101, #132, #153 and #180) and the results were computed in the upper-bound mode. The internal dose of PCBs attributable to the cats' alimentary lipid intake ranged from 32.4 to 1,446 ng/g (P50 165; mean 258). The Wilcoxon test revealed significantly lower PCB burden in "outdoor" groups than in "indoor" groups. Age correlated well with the heptachlorinated and most bio-accumulative congener, PCB #180, and slightly with hexachlorinated PCBs #138 and #153. Contamination attributable to house dust collected in 15 living-rooms ranged from 10.0 to 279 ng/g dry weight (P50 97.4; mean 94.4). Exposure estimates indicated a 0.6-16 ng/kg bw range of daily ∑6 PCB intake from a default value of 200 mg/cat of dust ingestion. The intake of PCBs due to dust ingestion fell within the same order of magnitude as that computed from a 60 g daily intake of commercial dry pet foods, while inhalation accounted for 0.21-8.2 ng/kg bw/day, on setting the nominal ∑6 PCB contamination in outdoor and indoor air at 0.37 and 15 ng/m3, respectively. Italian indoor cats could be exposed to higher levels of ∑6 PCBs than the Reference Dose (RfD) of 10 ng/kg/bw/day; this supports the World Health Organization's statement that the quality of the indoor environment is a major determinant of health.

Comparative analysis of metagenomes of Italian top soil improvers.

Biosolids originating from Municipal Waste Water Treatment Plants are proposed as top soil improvers (TSI) for their beneficial input of organic carbon on agriculture lands. Their use to amend soil is controversial, as it may lead to the presence of emerging hazards of anthropogenic or animal origin in the environment devoted to food production. In this study, we used a shotgun metagenomics sequencing as a tool to perform a characterization of the hazards related with the TSIs. The samples showed the presence of many virulence genes associated to different diarrheagenic E. coli pathotypes as well as of different antimicrobial resistance-associated genes. The genes conferring resistance to Fluoroquinolones was the most relevant class of antimicrobial resistance genes observed in all the samples tested. To a lesser extent traits associated with the resistance to Methicillin in Staphylococci and genes conferring resistance to Streptothricin, Fosfomycin and Vancomycin were also identified. The most represented metal resistance genes were cobalt-zinc-cadmium related, accounting for 15-50% of the sequence reads in the different metagenomes out of the total number of those mapping on the class of resistance to compounds determinants. Moreover the taxonomic analysis performed by comparing compost-based samples and biosolids derived from municipal sewage-sludges treatments divided the samples into separate populations, based on the microbiota composition. The results confirm that the metagenomics is efficient to detect genomic traits associated with pathogens and antimicrobial resistance in complex matrices and this approach can be efficiently used for the traceability of TSI samples using the microorganisms' profiles as indicators of their origin.

Occurrence of imidacloprid, carbendazim, and other biocides in Italian house dust: Potential relevance for intakes in children and pets.

The occurrence of pesticides intended for non-agricultural use was investigated in 206 dust samples drawn from vacuum-cleaner bags from residential flats in Italy. The multi-residue analysis targeted on 95 different active principles was performed with UPLC-MS/MS, with a Limit of Quantification (LOQ) of 0.008 µg/g dry weight. The results indicated the presence of imidacloprid (IMI) and carbendazim (CARB) in 30% and 26% of the samples, with a mean and P95 concentration between 1.6 and 39 and between 0.08 and 4.9 µg/g, respectively. Combined presence of two biocides was noted in 19.4% samples, of three biocides in 9.2% samples, of four biocides in 3.4% samples, and of five and six biocides in 0.5% and 1% samples, respectively. According to the estimated dust intake in infants/toddlers aged 6-24 months (16-100 mg d-1) and cats (200 mg d-1), it was possible to obtain risk characterization with respect to the Acceptable Daily Intake (ADI) for IMI of 0.060 mg/kg body weight (bw) proposed by the European Food Safety Authority (EFSA) and the chronic Population Adjusted Dose (cPAD) of 0.019 mg/kg bw d-1 by US-EPA. Under the worst-case scenario, the presence of IMI in dust indicates potential exceedance of the cPAD in kittens, to be considered as sentinel also accounting for combined exposure. This study highlights the relevance of consumer empowerment about the responsible use of pesticides as biocidal products in indoor environment.

Individual methylmercury intake estimates from local seafood of the Mediterranean Sea, in Italy.

A Seafood Frequency Questionnaire (SFQ) broken down in more than 42 items with 8-week coverage was interview-administered to 278 adults aged 19-82years (167 women, 98 in the reproductive age 19-45years, and 111 men), resident on the Italian Mediterranean shore and frequent buyer at local fish markets. Methylmercury (MeHg) intake on individual basis was estimated for a selected occurrence equal to the median value+Median Absolute Deviation (MAD) in each seafood species reported (conservative scenario). MeHg occurrence was derived from an extensive seafood database referred to years 2009-2011. Accounting for an average body weight of 62.2kg, 24.6% of women resulted overexposed with respect to the European Food Safety Authority (EFSA) Tolerable Weekly Intake (TWI) for MeHg of 1.3µg/kg bw, with a mean of 0.92µg/kg bw. In the vulnerable group aged 19-45years, 29.6% exceeded the TWI. Rather than the amount of seafood consumed, the seafood choice appears to be the main determinant of the MeHg intake. Risk awareness was reported in the 49% of SFQs. Uncertainties related to such estimates from questionnaires are discussed, in order to give adequate health recommendations without compromising seafood consumption in the Mediterranean region.

Investigation on gabapentin residues in eggs from free-range hens exposed to saline slags from pharmaceutical industry.

A simple, sensitive and rapid liquid chromatography-tandem mass spectrometry method (LC-MS/MS) was developed and validated to monitor the presence of gabapentin as environmental contaminant in albumen and yolk of eggs from grazing flocks exposed to open air stored saline wastes from pharmaceutical industry. The method involved a simple liquid extraction followed by a gradient elution with formic acid 0.2 % and acetonitrile in reverse phase. ESI ionization was performed in positive ion mode. The tandem mass spectrometer was operated in multiple reaction monitoring mode. The calibration curves were linear in the concentration range from 5 to 400 ng/g for the two matrices with correlation coefficients that exceeded 0.990. The limits of quantitation were 12.0 and 14.8 ng/g in albumen and yolk, respectively. Results are discussed in light of the pharmacokinetics of gabapentin in experimentally exposed hens, accounting for the top soil intake in such free grazing animals.

Safe and sustainable fish and seafood system and per- and poly-fluorinated substances occurrence: the role of PFAS toxicity in the assessment.

Fish and seafood are valuable sources of both nutrients and organic contaminants. The expansion of the analytical per- and polyfluoroalkyl substances (PFAS) panel with toxicological characterisation necessitates an update of PFAS intake assessment and management within the context of cumulative exposure. Benthic and demersal seafood, such as clams, squid, and cuttlefish, are more prone to contamination with C9-C14 perfluorocarboxylic acids, exhibiting the highest relative potency factors in terms of immunotoxicity, according to the grid recently proposed by the European Commission Scientific Committee on Health, Environment, and Emerging Risk. Based on the Italian food consumption database referring to demersal and benthic biota such as squid, cuttlefish, crustaceans, and clams, a toxicology-based intake scenario was drafted to highlight the relevant contribution of such wild species to PFAS intake, well above the provisional health-based guidance value of 4.4 ng/kg body weight per week. Ensuring consistency between PFAS reduction and substitution policies, environmental quality standards for water bodies, and the issuance of advisories and regulations regarding safe and sustainable intake of fish and seafood is crucial. This is done to prevent a loss of accountability for institutional bodies, which aim to protect fragile (sensitive and vulnerable) groups from PFAS exposure and simultaneously promote 'blue growth' as a sustainable food production system.

Assessment of the combined inputs of antimicrobials from top soil improvers and irrigation waters on green leafy vegetable fields.

Sustainable food systems involve the recycling of biowaste and water. This study characterizes thirty-one top soil improvers of anthropogenic, animal, and green waste origin, along with eleven irrigation waters from rivers, channels, and civil wastewater treatment plants (cWWTPs) for the presence of antimicrobials. Liquid chromatography coupled with hybrid High-Resolution Mass Spectrometry (LC-HRMS/MS) was employed to identify forty-eight drugs belonging to the classes of sulfonamides (11), tetracyclines (7), fluoroquinolones (10), macrolides (12), amphenicols (3), pleuromutilins (2), diaminopyrimidines (1), rifamycins (1) and licosamides (1). Sludge from cWWTPs, animal manure, slurry, and poultry litter exhibited the highest loads for sulfonamides, tetracyclines, fluoroquinolones and macrolides (80, 470, 885, and 4,487 ng g-1 wet weight, respectively) with nor- and ciprofloxacin serving as markers for anthropogenic sources. In compost and digestate, antimicrobials were found to be almost always below the limits of quantification. Reused water from cWWTPs for irrigation in open-field lettuce production were contaminated in the range of 12-221 ng L-1 with sulfonamides, tetracyclines, and fluoroquinolones, compared to very few detected in channels and surface waters. The Antimicrobials Hazard Index (HI), based on the Predicted No Effect Concentration for Antimicrobial Resistance (PNECAMR), was significantly >100 in contaminated topsoil improvers from urban and animal sources. Accounting for worst-case inputs from topsoil improvers and irrigation water, as well as dilution factors in amended soil, fluoroquinolones only exhibited an HI around 1 in open fields for lettuce production. The origin of topsoil improvers plays a pivotal role in ensuring safe and sustainable leafy vegetable production, thereby mitigating the risk of Antimicrobial Resistance (AMR) onset in food-borne diseases and the transfer of AMR elements to the human gut flora.

COVID-19 in meat plants: a survey framed within a Target Prevention Plan, in Italy.

BACKGROUND: During the COVID-19 pandemic, several outbreaks have been recorded worldwide in industrial slaughterhouses and meat-processing plants. Competent Italian health authorities at regional and provincial levels agreed on a risk-oriented control plan. METHODS: Advocacy actions were activated, targeting meat plant managers and related food business operators. A questionnaire focused on the inventoried risk factors from literature was developed and administered voluntarily to interested stakeholders. In addition, an outbreak questionnaire was proposed to the prevention department of local health units. RESULTS: From 2021 to 2022, 333 advocacy and 24 outbreak questionnaires on 4,765 inventoried plants were collected. The lack of awareness in updating the Risk Assessment Document for COVID-19, non-instrumental body temperature checks at the entrance, working force from different subcontractors, poor hygiene in shared places, and insufficient ventilation were the main critical points recorded. CONCLUSIONS: Results provide a post hoc review with an eye toward future zoonotic pandemics.

Sustainable dairy farming and fipronil risk in circular feeds: insights from an Italian case study.

Circular feeds, such as grain dry distillers, citrus pulp, cane molasses, and potatoes peels, are co-products of biomass processes. They are currently proposed in animal nutrition to improve the environmental and economic sustainability of the food production chain. In this paper, we report a case study involving fipronil, a pesticide currently not authorized for agriculture within the EU, but used in the Americas, Eastern Europe, and Asia. Fipronil was found at a mean level of 0.49 mg/kg, in a grain dry distiller batch administered to dairy cows. This finding, along with other evidence of potential fipronil presence in feed materials, prompted us to evaluate the risk to food safety and food security from 12 different conventional and sustainable feeding regimens. To this purpose, we considered a fipronil feed-to-milk carry-over rate of 0.52, the tolerance levels in fodders and food from The EU, Codex Alimentarius, and US-EPA, and the Acceptable Daily Intake (ADI) of 0.0002 mg/kg body weight for adverse effects on thyroid function in dairy cows. Under a conservative scenario, fipronil-contaminated potato peels and grain distillers in the feeding regimens may play a pivotal role in exceeding the EU Maximum Residue Level (MRL) in bovine milk and fat (0.005 and 0.030 mg/kg, respectively). Hay-based diets with soybean hulls and cane molasses show negligible risks (Hazard Index ∼ 1). In all cases, the ADI exceedance suggests the need to evaluate thyroid function in dairy cows exposed to fipronil as a food security factor.

Occurrence and pattern of legacy and emerging per- and Poly-FluoroAlkyl substances (PFAS) in eggs of loggerhead turtle Caretta caretta from western Mediterranean.

Per-and Poly-FluoroAlkyl Substances (PFAS) are a class of persistent, toxic, and mobile and chemicals both from industrial sources and from the use and disposal of Consumers products containing PFAS, whose concentration in marine food webs could pose a toxicological risk for biota and humans. In 2021, unhatched eggs were sampled from 41 loggerhead turtle Caretta caretta nests from the Italian shores of the Campania Region (Southern Italy). Whole eggs were analysed for the presence of 66 legacy and emerging PFAS with Liquid Chromatography coupled to Hybrid High Resolution Mass Spectrometry. A median Σ66 Per- and Poly-FluoroAlkyl Substances value of 3.34 ng/g egg fresh weight was found; perfluoroctane sulfonate (PFOS) represented the most contributing congener (47%), followed by perfluoro-n-undecanoic acid, perfluoro-n-tridecanoic acid, perfluoro-n-decanoic acid, perfluoro-n-decanoic acid, and perfluoro-n-tetradecanoic acid, respectively. Such compounds showed a log-norm distribution, suggesting found concentrations could represent the baseline levels in the considered sampling area. Emerging ChloroPolyFluoroPolyEthers Carboxylic Acids (ClPFECAs) were found in 20 out of 41 samples in the range 0.01-1.59 ng/g. Four samples had 20-100 fold higher concentration compared to that of other samples, suggesting the presence of hot spot areas possibly related to presence of fluoropolymer-based marine litter turtles may ingest. The analysis of two paired eggs/liver samples recovered from stranded animals revealed PFAS concentration in the same order of magnitude, supporting the role of vitellogenin in their selective transfer to yolk. Significant (P = 0.0155) Kendall negative correlation coefficient of -0.2705 among PFOS content in eggs and the recorded hatching success prompts for further investigation on associated exposure assessment and related eco-toxicity risk. This work reports for the first time PFAS presence in georeferenced loggerhead turtle eggs of the Mediterranean Sea and results represent a starting point to study PFAS time-trends in this vulnerable species.

Nitrite in feed: from animal health to human health.

Nitrite is widely consumed from the diet by animals and humans. However the largest contribution to exposure results from the in vivo conversion of exogenously derived nitrate to nitrite. Because of its potential to cause to methaemoglobin (MetHb) formation at excessive levels of intake, nitrite is regulated in feed and water as an undesirable substance. Forages and contaminated water have been shown to contain high levels of nitrate and represent the largest contributor to nitrite exposure for food-producing animals. Interspecies differences in sensitivity to nitrite intoxication principally result from physiological and anatomical differences in nitrite handling. In the case of livestock both pigs and cattle are relatively susceptible. With pigs this is due to a combination of low levels of bacterial nitrite reductase and hence potential to reduce nitrite to ammonia as well as reduced capacity to detoxify MetHb back to haemoglobin (Hb) due to intrinsically low levels of MetHb reductase. In cattle the sensitivity is due to the potential for high dietary intake and high levels of rumen conversion of nitrate to nitrite, and an adaptable gut flora which at normal loadings shunts nitrite to ammonia for biosynthesis. However when this escape mechanism gets overloaded, nitrite builds up and can enter the blood stream resulting in methemoglobinemia. Looking at livestock case histories reported in the literature no-observed-effect levels of 3.3mg/kg body weight (b.w.) per day for nitrite in pigs and cattle were estimated and related to the total daily nitrite intake that would result from complete feed at the EU maximum permissible level. This resulted in margins of safety of 9-fold and 5-fold for pigs and cattle, respectively. Recognising that the bulkiness of animal feed limits their consumption, these margins in conjunction with good agricultural practise were considered satisfactory for the protection of livestock health. A human health risk assessment was also carried out taking into account all direct and indirect sources of nitrite from the human diet, including carry-over of nitrite in animal-based products such as milk, eggs and meat products. Human exposure was then compared with the acceptable daily intake (ADI) for nitrite of 0-0.07 mg/kg b.w. per day. Overall, the low levels of nitrite in fresh animal products represented only 2.9% of the total daily dietary exposure and thus were not considered to raise concerns for human health. It is concluded that the potential health risk to animals from the consumption of feed or to man from eating fresh animal products containing nitrite, is very low.

Mercury occurrence in Italian seafood from the Mediterranean Sea and possible intake scenarios of the Italian coastal population.

Mercury (Hg) settlements in the Mediterranean Sea determine a potential toxicological relevance of seafood intakes for coastal populations. To assess this possibility, fish, molluscs, and crustaceans of commercial size of 69 different species were sampled and analyzed for total mercury (Hg(TOT)) from georeferenced areas and evaluated for their compliance with the European Union Maximum Residue Limits of 0.5 and 1.0 mg/kg wet weight (ww). Accounting for the weekly estimated seafood intake in the Italian coastal population (mean 469-626 g/person/week) it was then possible to recover threshold contamination values in seafood. Under a Tolerable Weekly Intake of 1.3 µg/kg/bw/week, a threshold seafood contamination <0.10 mg/kg ww has been derived for sensitive groups. A suitable algorithm based on the parallel MeHg and Hg(TOT) analysis on the most consumed species, helped to refine the uncertainties related to the conservative assumption in seafood all the Hg(TOT) present is in form of MeHg. This work aims to improve the link between the risk management and risk assessment strategies, with the identification of those fish and seafood species, that, when regularly consumed, could determine or prevent potential Hg(TOT)/MeHg overintakes in sensitive groups.

Impact of improved upper endoscopy quality on detection of gastric precancerous lesions.

OBJECTIVE: Intestinal metaplasia (IM) is the point of no return in gastric carcinogenesis, and patients with extensive (antrum plus corpus) IM are at high risk of developing gastric cancer. We evaluated the impact of improved gastroscopy quality on the detection of gastric IM in an Italian area at high risk for gastric cancer. METHODS: Data of consecutive patients with gastric biopsies according to the updated Sydney System observed in 2013, 2016 and 2019 resulting in IM diagnosis were retrieved. In the first period, endoscopy was performed with standard white light instruments. In the second period, preendoscopic gastric preparation was administered, and the examinations lasting at least 7 min with standard endoscopes were performed. In the third period, the latter procedure was followed, with virtual chromoendoscopy equipped instruments. The prevalence of IM in any gastric site and that of extensive IM were compared among the three periods. RESULTS: Data of 3485 patients were available. The detection of IM in at least one gastric site increased from 29.9 to 33.6% and 34.5% (95% CI, 32.1-36.8) in the first, second and third period, respectively. The difference was statistically significant between the first and last (P = 0.02; OR, 1.24; 95% CI, 1.04-1.48) period. When considering extensive IM, the detection increased from 4.28 to 6.1% and 5.44%, although the difference failed to reach statistical significance (P = 0.076). CONCLUSION: Our data showed that implementation of a quality protocol increased the probability to detect IM in the stomach, allowing us to select patients deserving stricter follow-up.

PCDD, PCDF, AND DL-PCB analysis in food: performance evaluation of the high-resolution gas chromatography/low-resolution tandem mass spectrometry technique using consensus-based samples.

Due to safety concerns regarding dietary exposure to POPs, regulatory bodies are issuing detailed guidelines for testing for polychlorodibenzodioxins (PCDDs) and polychlorodibenzofurans (PCDFs) ('dioxins') and dioxin-like (DL)-PCBs in foods of animal origin. Determination of the aforesaid chemicals at regulatory levels requires highly selective and sensitive testing techniques. The new generation of low-resolution mass spectrometers (triple quadrupoles) allows very low levels of quantification to be reached (in the order of tens of femtograms), thus suggesting a potential for their application in food and feed analysis. The performance of the low-resolution tandem mass spectrometry (LRMS/MS) approach with triple quadrupoles was assessed on a qualified set of food samples from proficiency tests (PTs) and defense analysis. Accuracy was tested comparing the results with data from high-resolution mass spectrometry (HRMS) and with consensus values from PTs. The cumulative TEQ results were characterized by deviations not exceeding 15% of PCDD + PCDF, DL-PCB, and PCDD + PCDF + DL-PCB (TEQ(TOT)) reference consensus values (sample TEQ(TOT) range, 2.29-25.1 pgWHO-TEQ(97)/g fat). Congener analytical variabilities did not influence significantly the WHO-TEQ(97) outcome of the corresponding sample. This preliminary performance evaluation highlights the potential of LRMS/MS as a routine technique for quantitative analysis of PCDDs, PCDFs, and DL-PCBs in food.

Evaluation of the Acaricidal Effectiveness of Fipronil and Phoxim in Field Populations of Dermanyssus gallinae (De Geer, 1778) from Ornamental Poultry Farms in Italy.

The poultry red mite Dermanyssus gallinae is the most important blood-sucking ectoparasite in egg-laying hen facilities. The aim of this study was to evaluate the in vitro acaricidal activity of different concentration of authorized (phoxim, ByeMite®, 500 mg/mL) and unauthorized (fipronil, Frontline® 250 mg/100 mL spray) molecules on 14 field isolates of D. gallinae collected from different ornamental poultry farms from different Italian regions. The sensitivity test was performed by contact exposure to four concentrations of each insecticide diluted at 1:5 (10,000-2000-400-80 ppm for phoxim, 500-100-20-4 ppm for fipronil) on a filter paper. The effectiveness of the treatment was significantly (p < 0.0001) associated with the dose of the pesticide used. Considering the mean lethality, phoxim has greater efficacy compared to fipronil (p < 0.001). A great variability of lethality rate was observed with the increase in fipronil dilution; conversely, for phoxim, some outliers were observed, particularly in one farm, suggesting the hypothesis that a certain degree of resistance in the mite population could occur possibly as a consequence of the continual contact with the molecule. This underlines the importance of the use of licensed products administered at correct dosages and the need for alternative molecules to avoid the onset of drug resistance phenomena.

Argument mining as rapid screening tool of COVID-19 literature quality: Preliminary evidence.

Background: The COVID-19 pandemic prompted the scientific community to share timely evidence, also in the form of pre-printed papers, not peer reviewed yet. Purpose: To develop an artificial intelligence system for the analysis of the scientific literature by leveraging on recent developments in the field of Argument Mining. Methodology: Scientific quality criteria were borrowed from two selected Cochrane systematic reviews. Four independent reviewers gave a blind evaluation on a 1-5 scale to 40 papers for each review. These scores were matched with the automatic analysis performed by an AM system named MARGOT, which detected claims and supporting evidence for the cited papers. Outcomes were evaluated with inter-rater indices (Cohen's Kappa, Krippendorff's Alpha, s* statistics). Results: MARGOT performs differently on the two selected Cochrane reviews: the inter-rater indices show a fair-to-moderate agreement of the most relevant MARGOT metrics both with Cochrane and the skilled interval scores, with larger values for one of the two reviews. Discussion and conclusions: The noted discrepancy could rely on a limitation of the MARGOT system that can be improved; yet, the level of agreement between human reviewers also suggests a different complexity between the two reviews in debating controversial arguments. These preliminary results encourage to expand and deepen the investigation to other topics and a larger number of highly specialized reviewers, to reduce uncertainty in the evaluation process, thus supporting the retraining of AM systems.

Outbreak of SARS-CoV-2 B.1.617.2 (delta) variant in a nursing home 28 weeks after two doses of mRNA anti-COVID-19 vaccines: evidence of a waning immunity.

OBJECTIVES: To describe a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.617.2 (Delta) variant outbreak among residents (n = 69) and health workers (n = 69) of a small nursing home in northeastern Italy, with full vaccination coverage of 91% and 82%, respectively. Evaluation of the anti-Spike IgG titres 28 weeks after the mRNA vaccine booster dose against SARS-CoV-2 infection and severe coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: Sera were collected within 48 hours from the index case; anti-Spike IgG was determined (expressed as WHO binding antibody units (BAU)/mL) through a commercial quantitative assay; SARS-CoV-2 was diagnosed using RT-PCR, and full-genome sequencing was performed for lineage characterization. Residents were grouped according to anti-Spike IgG titres (≤50, 51-1000 and > 1000 BAU/mL) and the resulting protection against infection and severe disease was measured. RESULTS: None of the health workers and 14 of the 59 (24%) residents fully vaccinated and without a previous SARS-CoV-2 infection showed anti-Spike IgG ≤50 BAU/mL (one-sided Fisher exact test, p 0.011). Among these residents, a level of anti-Spike IgG ≤50 BAU/mL resulted in a higher risk of SARS-CoV-2 infection (relative risk 1.55, 95% CI 1.17-2.05) and severe COVID-19 (relative risk 5.33, 95% CI 1.83-15.57). CONCLUSION: Low levels of SARS-CoV-2 neutralizing anti-Spike IgG in serum 28 weeks after the administration of the second dose parallel the waning of vaccine protection.

Natural history and outcome of hepatic vascular malformations in a large cohort of patients with hereditary hemorrhagic teleangiectasia.

BACKGROUND: Hereditary hemorrhagic telangiectasia is a genetic disease characterized by teleangiectasias involving virtually every organ. There are limited data in the literature regarding the natural history of liver vascular malformations in hemorrhagic telangiectasia and their associated morbidity and mortality. AIM: This prospective cohort study sought to assess the outcome of liver involvement in hereditary hemorrhagic telangiectasia patients. METHODS: We analyzed 16 years of surveillance data from a tertiary hereditary hemorrhagic telangiectasia referral center in Italy. We considered for inclusion in this study 502 consecutive Italian patients at risk of hereditary hemorrhagic telangiectasia who presented at the hereditary hemorrhagic telangiectasia referral center and underwent a multidisciplinary screening protocol for the diagnosis of hereditary hemorrhagic telangiectasia. Of the 502 individuals assessed in the center, 154 had hepatic vascular malformations and were the subject of the study; 198 patients with hereditary hemorrhagic telangiectasia and without hepatic vascular malformations were the controls. Additionally, we report the response to treatment of patients with complicated hepatic vascular malformations. RESULTS: The 154 patients were included and followed for a median period of 44 months (range 12-181); of these, eight (5.2%) died from VM-related complications and 39 (25.3%) experienced complications. The average incidence rates of death and complications were 1.1 and 3.6 per 100 person-years, respectively. The median overall survival and event-free survival after diagnosis were 175 and 90 months, respectively. The rate of complete response to therapy was 63%. CONCLUSIONS: This study shows that substantial morbidity and mortality are associated with liver vascular malformations in hereditary hemorrhagic telangiectasia patients.