A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection.

BACKGROUND: Acral chilblain-like lesions are being increasingly reported during COVID-19 pandemic. However, only few patients proved positivity for SARS-CoV-2 infection. The relationship between this skin manifestation and COVID-19 infection has not been clarified yet. OBJECTIVE: To thoroughly characterize a prospective group of patients with chilblain-like lesions and to investigate the possible relationship with SARS-CoV-2 infection. METHODS: Following informed consent, patients underwent (i) clinical evaluation, (ii) RT-PCR and serology testing for SARS-CoV-2, (iii) digital videocapillaroscopy of finger and toe nailfolds, (iv) blood testing to screen for autoimmune diseases and coagulation anomalies, and (v) skin biopsy for histopathology, direct immunofluorescence and, in selected cases, electron microscopy. RESULTS: Nineteen patients, all adolescents (mean age: 14 years), were recruited. 11/19 (58%) of them and/or their cohabitants reported flu-like symptoms one to two months prior to skin manifestation onset. Lesions were localized to toes and also heels and soles. Videocapillaroscopy showed pericapillary oedema, dilated and abnormal capillaries, and microhaemorrhages both in finger and toe in the majority of patients. Major pathological findings included epidermal basal layer vacuolation, papillary dermis oedema and erythrocyte extravasation, perivascular and perieccrine dermal lymphocytic infiltrate, and mucin deposition in the dermis and hypodermis; dermal vessel thrombi were observed in two cases. Blood examinations were normal. Nasopharyngeal swab for SARS-CoV-2 and IgG serology for SARS-CoV-2 nucleocapsid protein were negative. Importantly, IgA serology for S1 domain of SARS-CoV-2 spike protein was positive in 6 patients and borderline in 3. CONCLUSIONS: Chilblain-like lesions during COVID-19 pandemic have specific epidemiologic, clinical, capillaroscopic and histopathological characteristics, which distinguish them from idiopathic perniosis. Though we could not formally prove SARS-CoV-2 infection in our patients, history data and the detection of anti-SARS-COV-2 IgA strongly suggest a relationship between skin lesions and COVID-19. Further investigations on the mechanisms of SARS-CoV-2 infection in children and pathogenesis of chilblain-like lesions are warranted.

Nitrous oxide occupational exposure in conscious sedation procedures in dental ambulatories: a pilot retrospective observational study in an Italian pediatric hospital.

BACKGROUND: Nitrous oxide has a proven clinical efficacy in conscious sedation. At certain environmental concentrations it may pose a health risk to chronically exposed healthcare workers. The present pilot study aims at evaluating the exposure to nitrous oxide of dental ambulatory personnel of a pediatric hospital. METHODS: A descriptive study design was conducted in two phases: a bibliographic analysis on the environmental safety policies and a gas concentration analysis in the dental ambulatories of a pediatric hospital, detected every 6 months from December 2013 to February 2017 according to law provisions. The surveys were carried out using for gas analysis a photoacoustic spectrometer Innova-B&K "Multi-gas monitor model 1312" and Innova-B&K "Multi-sampler model 1309". The biological analysis and monitoring have been carried out on staff urine. RESULTS: The analyses were performed during 11 dental outpatient sessions on pediatric patients. All the patients were submitted to the same dental procedures, conservative care and dental extractions. The pediatric patients were 47 (23 males, 24 females; age range 3-17 years; mean age 6,63, SD ± 2,69) for a mean of 4,27 (SD ± 1,49) per session., The mean environmental concentration of nitrous oxide during the sessions was 24.7 ppm (SD ±16,16). A correlation was found between urinary nitrous oxide concentration of dentists (Pearson's correlation 0.786; p = 0.007) and dental assistants urines (Pearson's correlation 0.918; p < 0.001) and environmental concentrations of nitrous oxide. Weak negative correlations were found between age and sex of patients and environmental concentrations of nitrous oxide. The mean values of the biological monitoring data referring to all the outpatient sessions are lower than the reference values foreseen in accordance to the regulations in force on nitrous oxide concentration. CONCLUSIONS: The mean environmental concentration values recorded in our study are below the limit of 50 ppm considered as a reference point, a value lower than those reported in other similar surveys. The results of the present study provide a contribution to the need to implement technical standards, criteria and system requirements for the dental ambulatories, to date not yet completely defined, and cannot be assimilated to the ones established for the surgical rooms.

[Artificial lighting and blue light in the operating room: what risks for the surgeon?]. / Illuminazione artificiale e luce blu in sala operatoria: quali rischi per il chirurgo?

BACKGROUND: Lighting in operating rooms must ensure conditions of visual comfort, wellbeing and safety when procedures are being carried out, so as to preserve  the health of both workers and patients. OBJECTIVES: In this study we attempted to develop a methodology for specifically assessing the risk for surgeons of exposure to blue light, simulating the surgeon's real working conditions. Visual comfort was also assessed by measuring maintained illuminance (Em) and the luminance levels in the visual task area within the operating field. METHODS: Blue light exposure was measured by an OCEAN OPTICS-QE65000 spectroradiometer and a LSI-Lastem model Z-Lux radiometer, while for lighting measurements, a videophotometer and luxmeter were used. RESULTS: Results show that the surgeons were exposed to blue light values lower than the limit of effective radiance LB= 100 W m-2 sr-1 foreseen by European Directive 2006/25/EC. For visual comfort, significant differences in illumination were observed between surrounding areas and the visual task areas, with very high luminance values measured in most of the observation points. CONCLUSIONS: In this case the measured values confirm that the workers were daily exposed to unsuitable luminance contrasts that can cause eyestrain. Given such results and considering the task analysis, we proposed to extend health surveillance to workers performing activities such as precision surgery for prolonged periods.

PTSD prevalence and associated risk factors after a fire disaster that broke out in a paediatric hospital: a cross-sectional study.

BACKGROUND: Several studies have shown a higher risk of psychological problems in health care workers exposed to serious occupational stressors. OBJECTIVES: The aim of the present study was to assess the presence of Post-traumatic Stress Disorder (PTSD) and possible risk factors in a sample of 32 workers who were at the same time rescuers and victims of a fire that broke out in the neonatal intensive care unit of a large paediatric hospital. METHODS: Immediately and six months after the event, the subjects underwent a study protocol aimed at the diagnostic assessment of PTSD, investigated via the Clinician-Administered PTSD Scale (CAPS) and the Impact of Event Scale-Revised (IES-R). RESULTS: Out of the 30 subjects examined (two were missing), six showed the diagnostic criteria for a current PTSD. Risk factors for PTSD onset were a prior psychiatric disorder, the level of involvement in the fire disaster and the presence of phobias in the days immediately after the event. Gender and level of education approached statistical significance. CONCLUSIONS: The high prevalence of PTSD found in this sample was due to the fact that the risk of death or serious injury involved infants.

[Occupational exposure to sevoflurane in pediatric operating rooms: the multi-point sampling method for risk assessment]. / Esposizione professionale al sevoflurano nelle sale operatorie di pertinenza pediatrica: il contributo del monitoraggio ambientale con tecnica multi-punto nella valutazione del rischio.

Several studies have shown that occupational exposure to anesthetic gases might be higher during pediatric surgery, probably due to the increased use of inhalational induction techniques. Our study aims to assess the level of exposure to sevoflurane in two rooms of pediatric surgery, using multi-point sampling method for environmental monitoring. The gas concentrations as well as its dispersion were measured in strategic points in the rooms for a total of 44 surgical interventions. Although the average of these concentrations has been rather low (1.32, SD +/- 1:55 ppm), the results obtained have documented a significant distribution kinetics difference inside the rooms as function of multiple factors among which there were the anesthetic technique used and the team involved. Therefore the method described allows to correctly analyze the spread of anesthetic gases and suggests a different risk stratification which may be dependent on the professional work.

[Risk of non-coherent optical radiation in the operating room]. / Rischio da radiazioni ottiche artificiali non coerenti in sala operatoria.

In this study, we evaluated the exposure of operating room personnel to non-coherent optical radiation by measuring the emission of blue light generated by operating lights. The values we obtained were largely below the exposure limit value of 100 W x m(-2) x sr(-1) provided by Legislative Decree no. 81/08 and European Directive 2006/25/EC, showing how workers can be exposed for longer than 8 hours without risk of acute health effects, confirming what was already said in literature. This work demonstrates, therefore, that the risk of acute nature of photochemical retinal damage, caused by exposure to blue light, is absent, if not exceeded the exposure limit values, on the basis of the current knowledge, however, respect for exposure level cannot protect against a possible retinal damage from chronic exposure, related to the total dose accumulated by the worker in the long-term.

[Best practice in risk management of Neisseria meningitidis bacterial meningitis at nurseries]. / Best practice nel risk management della meningite batterica da Neisseria meningitidis negli asili.

In many contexts is often underestimated the biological risk and schools can be an example. Proof of this is the exclusion of work in the school from the example of the work activities of biohazard included in Annex XLIV of Legislative Decree 81/08. Our work proposes a protocol for risk management meningitis contagious in the specific environment of the nursery taking a cue from the specific experience gained by the Service of Prevention and Protection Bambino Gesù Children's Hospital following the course accreditation Joint Commision. This is primary prevention measures (training and information) and secondary (vaccination, reporting of suspected cases, chemoprophylaxis of contacts, contact tracing, counseling) to be applied consistently even and especially in the absence of sick people, at which time the shares are aimed exclusively to control its spread to be taken and monitored, with the cooperation of all subject involved in various capacities in the protection of the health of workers, within these specific working environments.

Prolonged in-hospital exposure to an infant with active pulmonary tuberculosis.

Active pulmonary tuberculosis was diagnosed in a 4-month-old infant 16 days after hospitalization; 186 exposed individuals were traced and one conversion detected. Although the risk of tuberculosis transmission in paediatric hospitals is low, paediatricians in low-incidence countries should maintain a high level of alert for timely identification of cases.

[Role of screening tests for indirect diagnosis of tuberculosis in health care workers: Mantoux and the new tests on blood ELISA]. / Ruolo dei test di screening nella diagnosi indiretta di tubercolosi negli operatori sanitari: la Mantoux e il nuovo test ELISA su sangue.

The Tuberculosis infection in recent years has become always more a threat. The failure in the attempt to stop it (O.M.S. Millennium Global Plan) brought to the revision of the world control strategy to at least contain this disease (The Global Plan to Stop TB 2006-2015). Due to these severe facts it is even more important now to elaborate more sensitive and specific methods to find out, as fast as possible, the infected cases. As of today, the main TB infection screening test is the Skin PPD test (Mantoux). Recently new tests for the population screening are in use; these tests are based on the evaluation of immunity cell-mediated. They (QFT-G) do not have the typical limits of the Skin Test and they are more suitable as serial tests and therefore more useful, according to us, in the screening programs of the TB infection in low prevalence countries, like Italy.