DNA damage in workers exposed to pigment grade titanium dioxide (TiO2) and association with biomarkers of oxidative stress and inflammation.

The present study was aimed at investigating DNA damage, micronuclei frequency and meta-nuclear alterations in buccal cells of workers involved in pigment-grade TiO2 production (15 exposed and 20 not-exposed). We also assessed associations of genotoxicity biomarkers with oxidative stress/inflammatory biomarkers in urine and exhaled breath condensate (EBC), as well as possible associations between biomarkers and reported respiratory symptoms. In spite of compliance with TiO2 Occupational Exposure Limits, results showed increased direct/oxidative DNA damage and micronuclei frequency in exposed workers. Genotoxicity parameters were associated with oxidative stress/inflammation biomarkers in urine and EBC, thus confirming that TiO2 exposure can affect the oxidative balance. Workers with higher genotoxic/oxidative stress biomarkers levels reported early respiratory symptoms suggesting that molecular alterations can be predictive of early health dysfunctions. These findings suggest the need to assess early health impairment in health surveillance programs and to address properly safety issues in workplaces where TiO2 is handled.

[The issue of medico-legal assessment of noise induced hearing loss: comparison of methods]. / II problema della valutazione medico-legale della ipoacusia da trauma acustico cronico: confronto tra metodi.

Audiogram classification is crucial for hearing protection of workers occupationally exposed to noise. The methods that have been proposed are based on two principles: the morphological evaluation of the audiometric curve (eg. Merluzzi-Pira-Bosio--MPB) or the average hearing loss on different frequencies (eg. Albera-Beatrice--AB). The purpose of this study was to classify audiograms compatible with chronic acoustic trauma performed at the Occupational Medicine Outpatient Clinic of CTO Hospital in Turin from 2004 to 2011 with the methods outlined in Guidelines published by SIMLII. A substantial agreement among the methods was observed. While MPB is the most appropriate method for secondary prevention, the AB would seem more appropriate for the verification of a permanent weakening that has to be reported to the competent legal authorities.

Empiema causado por Salmonella typhimurium / Pleural empyema caused by Salmonella typhimurium: a case report

Salmonella species are commonly associated with acute gastroenteritis due to ingestion of contaminated food or water. Extraintestinal infections are less frequent, and most of them occur in immunocompromised patients. We report a case of pleural empyema caused by Salmonella typhimurium, without previous diarrhea or fever. The patient evolved favorably after receiving adequate treatment.

El género Salmonella se caracteriza por causar infecciones en el tracto gastrointestinal, debido a la ingesta de alimentos o agua contaminada. También puede causar, con menor frecuencia, infecciones localizadas en diferentes órganos; esto se asocia con inmunodepresión. En este caso se describe un paciente con infección pleuropulmonar por Salmonella typhimurium, que no reportó antecedentes de diarrea previa. Evolucionó favorablemente con tratamiento adecuado.

[Early lung cancer detection in an occupational asbestos exposed population: clinical impact of low-dose computed tomography screening]. / Diagnosi precoce del tumore al polmone in una popolazione esposta professionalmente ad amianto--impatto clinico dello screening con TC spirale.

Lung cancer is the primary cause of cancer mortality in developed countries. Early detection and surgical resection is essential for the treatment of lung cancer. The introduction of low-dose spiral computed tomography (LDCT) is considered one of the most promising clinical research developments in early diagnosis of lung cancer. Our study is aimed at the evaluation of spiral CT in a cohort of subjects with a past occupational exposure to asbestos at high risk of developing lung cancer. 149 subjects were enrolled between 2007 and 2009 (the criteria for enrollment were date of birth between 1930-1961, no previous cancer and general good health, latency from the beginning of exposure > 10 years, exposure duration > 1 year, possibility to undergo to surgery). A helical low-dose CT (LDCT) of the chest was performed yearly and an evaluation protocol derived from IEO with a morphological analysis of nodules have been adopted. 13 nodules were diagnosed in the first CT, 7 in the second and 3 in the third but no invasive procedures have been taken and no lung cancer have been detected. Our early follow-up data aren't able yet to evaluate the effect of screening with LDCT on mortality but have do not confirm some of the literature initial results such as the Increase in cases of overdiagnosis (false positive) due to the high prevalence of benign lesions.

[The role of occupational physician in the application of the 2006 "agreement on workers' health protection through the good handling and use of crystalline silica and products containing it": the experience in mining sector]. / Il ruolo del medico competente nell'applicazione dell'accordo europeo sulla silice: l'esperienza nel settore estrattivo.

The 2006 "Agreement on Workers' Health Protection Through the Good Handling and Use of Crystalline Silica and Products Containing it" between social parts defines a standardization of exposition control methods and medical surveillance. The Occupational Physician is integral part in exposition evaluation process and risk stratification in which derives the medical surveillance program. This study presents a first application of the European agreement in mining sector and the role of Occupational Physician in the evaluation of the risk to define methods of prevention. In particular it will be precised the choice of homogenous groups, the classification of exposed workers from results of workplace monitoring, the choice of technical prevention and individual protection equipments, and then the strategy of medical surveillance.

Clinical and neuroimaging features of severely brain-injured patients treated in a neurosurgical unit compared with patients treated in peripheral non-neurosurgical hospitals.

Most European TBI patients are managed in peripheral hospitals without benefit of guidelines for transfer of such patients to neurosurgical units as needed. This report compares clinical features and outcomes in two series of severe TBI patients: those admitted to a neurosurgical centre or to a general hospital, all in the Piedmont Region of Italy. Of 630 patients with a GCS of 3-8, 351 were admitted to a centralized neurosurgical unit, and 279 were admitted and treated at a peripheral hospital. All patients had a CT scan read by a neurosurgeon on duty and were classified using the Marshall criteria as having a diffuse injury or non-surgical mass lesions. Outcomes were assessed between 6 months and 6 years using either the GOS Extended or the GOS. Independent variables were age, sex, GCS score and Marshall classification. All the examined factors were significantly different between the two groups (p<0.001). For patients admitted to the neurosurgical centre, age, Marshall classification of the CT and GCS were predictors of a favourable outcome, while for patients treated in general hospitals, Marshall classification of the CT, gender and age were predictors of a favourable outcome. Patients admitted to neurosurgical centres are different from those treated in general hospitals not having these specialized facilities and personnel. The absence of guidelines for the transfer of these patients for more advanced care are lacking and should be the focus of new studies on patient referral.

[Epidemiologic research on asbestos related disease in ENEL SpA electricity production plant maintenance]. / Indagine epidemiologica sulle patologie asbesto correlate nei lavoratori addetti ad attività di manutenzione nelle centrali di produzione di ENEL SpA.

Since many years research programs have been set up to study the relationship between asbestos occupational exposure and development of asbestos-related lung diseases in electricity production plants workers. In the year 2000 a new study of asbestos-related lung abnormalities prevalence in italian geothermal and idrothermal power plant maintenance workers was planned. The cohort comprised 3891 subjects. To meet the criteria, only workers in service for at least six months before 1990 and still in service at power plants in May 2000 were included in the study; chest X-rays were taken and made anonymous. Independent reading of X-rays was made by two groups of specialists, and a third reading of selected discordant readings X-rays was made by another group of specialists. A further diagnostic protocol (including HRCT) was planned when two out of three readings showed the presence of asbestos related lung abnormalities. The analysis was made on 3063 subjects (78.7% of the cohort). The number of asbestos-related abnormalities in two out of three X-ray readings was 122 (4%). The further diagnostic protocol, that included occupational and pathological anamnesis and HRCT, confirmed an asbestos-related occupational lung abnormalities in 41 cases (1.3% out of 3063 subjects). The prevalence of asbestos-related lung abnormalities among 3063 power plant maintenance workers was 1.3%. If all the cases of lung abnormalities so far detected (data are still provisional) had developed only in the power plant environment, and not in previous working activities, the prevalence of lung abnormalities would be extremely low. These data support the evidence of limited exposure levels to asbestos in this working environment And bears witness to the success of preventive measures to control this specific risk.

[Hapten selection for patch tests in the diagnosis of allergic contact dermatitis: epidemiologic data]. / La scelta degli apteni per i test epicutanei nella dignosi delle dermatiti allergiche da contatto: osservazioni epidemiologiche.

Aim of the study was to verify the reliability in clinical practice of patch testing with "standard" series and additional series of haptens for the diagnosis of occupational and non-occupational allergic contact dermatitis, evaluating positive reactions and relating those reactions to professional categories. A total of 392 out of 937 patients (41.8%) showed at least one positive reaction to "standard" series testing; the hapten most frequently noted as the cause of positive reaction was nickel sulphate. Professional categories that showed positive reactions to "standard" series most frequently were clerks, hairdressers and hospital auxiliary workers. Among 897 patients tested with nonstandard allergens, only 124 (13.8%) elicited at least one positive reaction, ammonium persulphate being the most frequently positive hapten. A dominant percentage of positive results was seen in hairdressers and cleaning personnel. No positive reactions were observed in a large number of haptens, tested more than 200 times. Haptens of "standard series" elicited a higher number of positive reaction than the additional series, even though there was a high specificity of few additional series haptens in some professional categories. Data suggest some caution in systematically testing additional series, despite a higher accuracy and diagnostic efficacy in some job categories.

[Degree of hepatitis C infection risk in the health care setting]. / Entità del rischio infettivo per virus dell'epatite C in ambito sanitario.

BACKGROUND: Hepatitis C virus is the most important aetiologic agent for non A-non B hepatitis. The study of the prevalence of hepatitis C in health care workers is of primary interest because of the possible chronic evolution and the risk of cirrhosis and liver cancer. OBJECTIVES: The purpose of this study was to determine the prevalence of HCV among health care workers in 5 main hospitals and local health units in Turin and analyze the influence of occupational and non occupational risk factors. METHODS: Health care personnel were administered anonymous questionnaires and testing for anti-HCV antibody was performed. RESULTS: Prevalence rates in 4517 health care workers was 1.97%; the prevalence was higher in elderly workers (> 45 years) than in younger ones. The risk analysis did not reveal any significant correlation between HCV seroconversion and accidental blood exposure. However, a significant correlation was found with non-occupational risk factors. Unapparent infection was an unimportant risk factor for seroconversion. CONCLUSIONS: Hepatitis C prevalence in the population under study was comparable to that found in the general population. These results point to the need to reconsider the assumption that there is an increase of risk of seroconversion for health-care workers, in the absence of any occupational accidental exposure to hepatitis C virus.

Evidence for the involvement of the IgE-basophil-mastocyte system in human acute post-streptococcal glomerulonephritis.

Several findings reveal the involvement of the IgE-basophil-mastocyte-platelet-activating-factor (PAF) system in human acute post-streptococcal glomerulonephritis. In the acute phases of the disease there is a transient, marked reduction in the circulating metachromatically staining basophils, indicating an in vivo basophil degranulation. The blood reservoirs of PAF are depleted. The number of metachromatic mastocytes in renal biopsy samples was very low and morphological aspects of degranulation were present. In vitro, we demonstrated basophil degranulation and PAF release in presence of exogenous streptococcal Ags after recovery. These findings suggest that the IgE-basophil-mastocyte-PAF system may play a role in human pathology, as has been shown in immune complex (Ic) deposition in acute serum sickness in rabbits.