Congenital cytomegalovirus infection: the state of the art and future perspectives.

Congenital cytomegalovirus (cCMV) infection is the most common congenital infection, with an estimated incidence of approximately one in 200 infants in high-income settings. Approximately one in four children may experience life-long consequences, including sensorineural hearing loss and neurodisability. Knowledge regarding prevention, diagnosis, and treatment increased in the recent years, but some challenges remain. In this review, we tried to summarize the current knowledge on both the obstetrical and pediatric areas, while also highlighting controversial aspects and future perspectives. There is a need to enhance awareness among the general population and pregnant women through specific information programs. Further research is needed to better define the classification of individuals at birth and to have a deeper understanding of the long-term outcomes for so defined children. Finally, the availability of valaciclovir medication throughout pregnancy, where appropriate, has prompted the assessment of a universal serological antenatal screening. It is recommended to establish a dedicated unit for better evaluation and management of both mothers and children.

Congenital toxoplasmosis and audiological outcome: from a case series to a suggestion of patient-based schedule.

Introduction: Sensorineural hearing loss (SNHL) has been suggested to be possibly related to congenital toxoplasmosis (CT), although its prevalence varies from 0% to 26%. This variance appears to be dependent especially on early timing of treatment. However, the available data are based on outdated studies conducted on small groups of patients that lack homogeneity. Therefore, to establish evidence-based guidelines for audiologic monitoring in CT, we conducted a comprehensive evaluation of a large case series over a long period of time. Patients and methods: This is a single-center, retrospective cohort that enrolled all infants and children who were exposed in utero to Toxoplasma gondii and/or congenitally infected between September 1980 and December 2022. They underwent standard serial audiological evaluations to detect possible SNHL at an early stage. The first evaluation was performed during the initial assessment to define the onset of congenital toxoplasmosis, with another evaluation conducted at least at 12 months of life. Results: We collected data from 1,712 patients, and 183 (10.7%) were diagnosed with CT. Among these cases, 78 children (42.6%) presented with symptomatic CT at the onset, exhibiting ocular findings (21.1%), clinical cerebral manifestations (6.1%), and/or abnormal findings on neuroimaging (35.5%). Therapy was administrated at the onset in 164 patients (89.6%) with 115 of them starting treatment prior to 2.5 months of age (0-388, median 32.00 ± 92.352 days of life). Only one patient presented with SNHL at the onset, but this was apparently unrelated to CT. The median number of audiological assessments was 2.2 ± 1.543 (2-10). No patients developed any grade of delayed hearing loss, both in treated and untreated groups. The median age at last audiological evaluation was 2.3 ± 2.18 years (1-8), although the median follow-up period was 12.4 years (±6.3), ranging from 1 to 27 years. Conclusions: Based on these data, it appears that SNHL may be less frequent in CT than previously assumed. We recommend conducting an audiological assessment at the onset (within the first 2.5 months of life) to comprehensively define the type of CT onset, and then conducting another evaluation within 9 months of life.

From building regulations and local health rules to the new local building codes: a national survey in Italy on the prescriptive and performance requirements for a new performance approach.

BACKGROUND: World Health Organization has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Building Regulations and Local Health Rules provide safety and building hygiene in construction practices. Currently the Italian Government is giving rise to a Building Regulation Type and the paper aims to verify the present contents of recent innovative Local Health Rules and Building Regulations of several Italian municipalities for supporting the performance approach of the future Building Regulations including hygienic issues. METHODS: The analysis examines both Building Regulations and Local Health Rules of a sample of about 550 cities, analysing some specific fields of interest: urban field, outdoor issues, housing features, housing restrictions, and qualitative aspects. RESULTS: The analysis focuses on some specific aspects defining the general data reported in Building Regulations and Local Health Rules, in particular around surfaces, heights, lighting and aeration ratio, basements and semi-basements, gas radon, building greenery, etc. CONCLUSION: The investigation permitted to have a wide vision on the present State of the Art in order to highlight some innovative aspects and design approaches of Building Regulations and Local Health Rules. New perspectives in the new regulations should have a performance approach, starting also from the recent SARS-CoV-2 pandemic.

Hygienic and sanitary standards of housing in Europe: a comparative analysis of nine countries.

In recent years, growing interest was devoted to housing conditions from both scientific community and public health, so they are now considered among the main environmental and social health determinants of health of the population. Aim of the study is to analyze and compare the current regulations regarding housing sanitary requirements in different Countries of the EU (Sweden, United Kingdom, Denmark, the Netherlands, France, Germany, Portugal, Spain) with the contents of the Italian Health Ministerial Decree 5th July 1975. From the websites of the official channels of the various countries the regulations have been downloaded. For the comparison, only the aspects of BCs concerning the scale of the building were examined; the comparison concerned all the requirements of the Health Ministerial Decree of 5.07.1975 and some other parameters (e.g. indoor chemical pollution, ionizing radiation, non-ionizing radiation) not provided for in the Ministerial Decree, treated in the other standards regulations, and relevant for the indoor well-being of the occupants. The authors observe a wide variability in the contents and in the formulation of the hygienic-sanitary requirements among the different Building Codes, above all as regards the dimensional data and some fundamental themes (e.g. heating systems, mechanical ventilation) whose treatment is often not it is updated with respect to the technological-scientific innovation consolidated over the past few years. A diverse approach among European Countries is also observed: from a market-oriented logic (e.g. UK), to a prescriptive one (Italy), to a functionality-oriented (the Netherlands). The comparative analysis we carried out made it possible to identify convergences and divergences in the standards analysed for the different European countries. As far as the Italian legislation on the usability of residential premises, finally, considering the health, social, environmental and economic trends, many standards contained in the MD 5th July 1975 should be reviewed and updated.

Towards an update of the Italian Ministerial Decree July 5th, 1975.

In recent years, the Scientific Community and the Public Health world, in general, have devoted increasing interest to housing conditions, which are considered, to date, one of the main environmental and social determinants of the population's health. In particular, the Scientific Community has identified and studied various indoor well-being factors (e.g. lighting, temperature, ventilation, air quality, etc.). Some of these factors have been regulated by laws and regulations at various levels: the availability of clear and updated health requirements dictated by the regulations is fundamental to effectively protect public health, especially in confined environments. In the present work, we propose a revision of the Italian Ministerial Decree of July 5th, 1975 titled Modificazioni alle istruzioni ministeriali 20 giugno 1896 relativamente all'altezza minima ed ai requisiti igienico sanitari principali dei locali d'abitazione (Modifications to the ministerial instructions of June 20th, 1896 regarding the minimum height and the main hygienic-sanitary requirements of living spaces) in order to update the definition of the essential elements that qualify a space as habitable from the hygienic-sanitary point of view, taking into account the evidence gathered from the technical and scientific literature on the requirements and contents of the Building Codes of the major European countries.

Vascular endothelial growth factor expression as a biomarker of prognosis in patients with chondrosarcoma, Ewing's sarcoma and osteosarcoma. Current concepts.

With the advent of the molecularly targeted therapies, identifying molecular therapeutic targets and molecolar marker is increasingly important, especially in neoplastic diseases. Several studies show VEGF is involved in neo-angiogenesis in many solid cancers, as breast, lung, renal, gastric carcinomas, through promoting endothelial cell growth and migration. Conversely the relationship between VEFG and tumours of the musculoskeletal system is yet unclear, in particular the role of VEGF has not yet been completely understood in these tumours. Chondrosarcoma, Ewing's Sarcoma and Osteosarcoma are the tumours of the musculoskeletal system in which the activity of VEGF has been closely studied. The present study aims to give an overview focused on the relationship between VEGF and these three cancers.

Infections in arthroscopy.

Infection is a rare complication of arthroscopic procedures, with an overall incidence estimated in less than 1%. However, the actual prevalence may be higher as many cases may go unreported. Despite low incidence, early diagnosis is of outmost importance in order to avoid devastating consequences, such as arthrofibrosis. Clinical presentation is usually not specific and may include, at varying degrees of severity: increasing pain and stiffness, local erythema, swelling, warmth, and fibrinous exudate. High temperature and signs of sepsis are not common but may be present in severe cases. Unfortunately, variable clinical presentation coupled with a low index of suspicion may result in delayed diagnosis. Several risk factors have been identified, mainly related to the surgical site, patient characteristics or the surgical procedure. The aim of this paper is to provide an overview on pathogenesis, risk factors, clinical presentation, diagnostic evaluation, and current treatment options of septic arthritis after an arthroscopic procedure. Since no relevant data are available on infections after hip, ankle or elbow arthroscopy, the present review is mainly focused on infections after shoulder and knee arthroscopic procedures.

Hygienic Requirements of Urban Living Environment in the Russian Federation and in Italy: a comparison.

AIM: Urban planning tries to contain and regulate the uncontrolled growth of cities, encouraging their sustainable development at environmental, social and health levels. In the present work, the authors compare the regulatory frameworks of the Russian Federation and of Italy, with particular attention paid to the urban aspects of living spaces. METHODS: Considering the extant normative production in the two countries, the authors examine national legislation for Italy and federal legislation for Russia, mainly taking into account the following aspects: urban planning tools and environmental and sanitary protection of living spaces. RESULTS: Hygienic-sanitary requirements regarding living environment in Russia are essentially expressed by two regulatory systems (SNiP and SanPiN), while in Italy they are regulated by the D.M. 07/05/1975. The main principles of urban planning in Russia are expressed by federal standards, while in Italy they are incorporated in the Municipal General Plan (PRG) and in the various local regulations, where all the superordinate regulations are summarized. Finally, aspects related to environmental quality in both countries are governed by various specific laws (federal and state); a complex system of rules that take into account potential impacts on health and the environment. CONCLUSIONS: The authors reckon that clear and updated regulatory tools should be developed, especially in Italy that lags behind, regarding the building and urban hygiene, relying on the most recent acquisitions of international scientific literature in order to guarantee the highest standards in Public Health safeguard.

Secondary femur fracture following treatment with anterograde nailing: the state of the art.

Cephalomedullary nailing (CMN) currently represents the best surgical technique for the treatment of intertrochanteric hip fractures. Although the success of CMN in terms of functional recovery and fracture healing, in clinical practice there are many complications. Later femur fracture following treatment of trochanteric fracture with CMN is not a very frequent complication but, when it occurs, its treatment is the most complex, because of the increase of peri-operative mortality. There are studies in literature, which have demonstrated that the incidence of this complication is about 0.5-3%. Diagnosis and classification are made with standard radiographs, using the AO classification and the modified Vancouver classification. In the actual literature, to determinate the predisposing factor to the secondary fractures, the authors focused their attention on patient-related and surgical related risk factors. The treatment is variable and it depends on the type and characteristics of fracture and device. Outcomes analyzed in literature were mortality and bone healing. The aim of this manuscript is to provide an overview of this topic and to describe the state of the art of the secondary fracture after surgical treatment with intramedullary nailing.

Transiliosacral fixation using the O-ARM2® and STEALTHSTATION® navigation system.

Pelvic fractures are quite uncommon, they represent only 2-8% of all fractures. Osteosynthesis with percutaneous trans-Iliosacral screw is recognized as one of the standard procedures for the treatment of unstable posterior pelvic ring lesions. Because of the high number of complications associated with the conservative treatment of these kind of lesions such as pain, limb heterometry, difficulty in walking and sexual disability, percutaneous fixation with trans-iliosacral screw has found wide use and has become very popular among orthopedic surgeons. This technique is indicated for the treatment of dislocations of the sacro-iliac joint, some types of sacral and iliac fractures or combinations of these lesions.

Strategies for Disease Prevention and Health Promotion in Urban Areas: The Erice 50 Charter.

The Erice 50 Charter titled "Strategies for Diseases Prevention and Health Promotion in Urban Areas" was unanimously approved at the conclusion of the 50th Residential Course "Urban Health. Instruments for promoting health and for assessing hygienic and sanitary conditions in urban areas", held from 29th March to 2nd April 2017 in Erice, at the "Ettore Majorana" Foundation and Centre for Scientific Culture and promoted by the International School of Epidemiology and Preventive Medicine "G. D'Alessandro" and the Study Group "Building Hygiene" of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI). At the conclusion of the intense learning experience during the Course, with more than 20 lectures, workshops and long-lasting discussions between Professors and Students, the participants identified the major points connecting urban features and Public Health, claiming the pivotal role of urban planning strategies for the management of Diseases Prevention and Health Promotion activities. The Erice 50 Charter is configured as a Decalogue for Healthy Cities and as a Think Tank for designing effective strategic actions and best practices to develop urban regeneration interventions and improve the urban quality of contemporary cities. The Decalogue is structured into the following key strategic objectives: 1. Promoting urban planning interventions that address citizens towards healthy behaviours; 2. Improving living conditions in the urban context; 3. Building an accessible and inclusive city, with a special focus on the frail population; 4. Encouraging the foundation of resilient urban areas; 5. Supporting the development of new economies and employment through urban renewal interventions; 6. Tackling social inequalities; 7. Improving stakeholders' awareness of the factors affecting Public Health in the cities; 8. Ensuring a participated urban governance; 9. Introducing qualitative and quantitative performance tools, capable of measuring the city's attitude to promote healthy lifestyles and to monitor the population's health status; 10. Encouraging sharing of knowledge and accessibility to informations. Finally, all the participants underlined that a multidisciplinary team, composed of Physicians specialized in Hygiene, Preventive Medicine, Public Health and Technicians as Architects, Urban planners and Engineers, is needed to deepen the research topic of Urban Health.

An overview of different health indicators used in the European Health Systems.

INTRODUCTION: In the European Union three different health systems could be defined according to service delivery, financing, and economic policies: Beveridge, Bismarck and Mixed system. Although health systems are hardly to compare, various organizations are developing methods assessing performance. In the present work the performance of the three systems were evaluated using European Community Health Indicators according to Organization for Economic Cooperation and Development. METHODS: The study has been conducted among the 28 states of the European Union using the following indicators: Standardized death rate for diseases of the circulatory system, standardized death rate of malignant neoplasms, road traffic accidents with injury, life expectancy at birth, incidence of Human Immunodeficiency Virus (HIV), infant deaths, pure alcohol consumption, infants vaccinated against Diphtheria Tetanus Pertussis (DTP), public and total expenditure on health over the period 2001-2010. RESULTS: The variation of health indicators over the observational time shows similar trend of circulatory system diseases and malignant neoplasms death rates, road accidents with injury, infant deaths, life expectancy at birth, public and total health expenditure. Some differences in the trend of HIV incidence, alcohol intake and DTP vaccination rates arise among systems. Grouping countries by health system paradigm and geographical area, resulted in a relevant heterogeneity (I2 ≥ 90%, Pvalue < 0.0001). No clear superiority of a given health delivery system was found with respect to other paradigms. CONCLUSIONS: In accordance with the evidence of our study, it can be stated that best performances are more likely to be linked to country specific economic factors. In conclusion, it was not possible to identify the best health system model.

Knowledge and training needs on built environment and indoor health of Italian public health residents: a national survey.

INTRODUCTION: The Working Group for Hygiene of Built Environment and the National Council of Residents of the Italian Society of Hygiene, Preventive Medicine and Public Health conducted a nation-wide survey to evaluate the knowledge and training needs on Built Environment and Indoor Health of Italian public health residents. RESULTS: The compliance was very high (52,4%), covering the totality of Italian postgraduate schools. The results underline a severe lack of theoretical formation and practical training, but also diffuse discrepancies across the country, and show a strong interest of residents on this topic. CONCLUSIONS: The authors propose to adopt a national core curriculum, and suggest some strategies to improve learning.

Public health and urban planning: a powerful alliance to be enhanced in Italy.

Urban planning has played and still plays a key role in improving urban health and indoor health. The authors sketch out the historical evolution of the relationships between Public Health and urban planning, in particular to what happened in Italy during the past 150 years. The authors suggest some lines for further research, but also describe some interventions that could obtain practical results in terms of health gains for the population.

Health inequalities and inadequate housing: the case of exceptions to hygienic requirements for dwellings in Italy.

In the past decades, Italian hygienic requirements for dwellings have been modified by multiple derogations. Aim of the present work is to analyse the derogations introduced at a national, regional, and local level. The most important derogations were related to the habitable use of semi-basements and garrets, and building restoration. The paper also describes the regulations regarding indemnity for infringement of building abuses. The authors underline the need for more uniformity and clarity in the determination of health standards of dwellings, as well as for a simplification of the existing legislation.

European cardiovascular mortality over the last three decades: evaluation of time trends, forecasts for 2016.

BACKGROUND: The circulatory diseases, in particular ischemic heart diseases and stroke, represent the main causes of death worldwide both in high income and in middle and low income countries. Our aim is to provide a comprehensive report to depict the circulatory disease mortality in Europe over the last 30 years and to address the sources of heterogeneity among different countries. METHODS: Our study was performed using the WHO statistical information system - mortality database - and was restricted to the 28 countries belonging to the European Union (EU-28). We evaluated gender and age time series of all circulatory disease mortality, ischemic heart diseases, cerebrovascular diseases, pulmonary and other circulatory diseases and than we performed forecast for 2016. Mortality heterogeneity was evaluated by countries using the Cochrane Q statistic and the I-squared index. RESULTS: Between 1985 and 2011 SDR for deaths attributable to all circulatory system diseases decreased from 440.9 to 212.0 x 100,000 in EU-28 and a clear uniform reduction was observed. Heterogeneity among countries was found to be consistent, therefore different analysis were carried out considering geographical area. CONCLUSIONS: We forecast a reduction in European cardiovascular mortality. Heterogeneity among countries could only in part be explained by both geographical and health expenditure factors.

A giant urinary bladder stone in the mummy of Lebanese Maronite Patriarch Joseph Tyan (1760-1820) and its environmental and nutritional implications.

INTRODUCTION: Historical sources and anthropological investigations, with the indispensable support of radiology, bring to light pathological evidence of the past. CASE PRESENTATION: The purpose of this article is to present the radiological investigation conducted on the mummy of the Maronite Joseph Tyan (1760-1820), a famous patriarch who guided the Lebanese Maronite community during a critical period of its history. The natural mummy of the Patriarch was temporarily removed from its burial site to certify the degree of preservation. Conventional radiography was necessary to determine the state of the internal organs and any physical abnormalities, and to clarify the degree of conservation of the mummy. DISCUSSION: Radiological analysis uncovered an exceptional case of a large urinary bladder stone. This pathological evidence confirms historical documentary sources that in the last years of his life the Patriarch suffered from abdominal pain and urinary problems. We can suppose that the environment and diet of the Maronite community, limited by restricted agricultural resources, was the possible cause of the urinary bladder stone, as today the epidemiology of these diseases demonstrates links with mainly cereal diets in rural areas.

Lighting requirements of dwellings: a comparison between Russian federation and Italy.

Good lighting is a key factor for indoor health and wellness. Hygienic regulations regarding illumination requirements have been elaborated much time ago and in different countries. The authors describe these requirements in Italy and in the Russian Federation, analysing their contents and issues and comparing them. The results show that the Russian ones are updated, more precise and complete. In conclusion, the authors stress the strong need for a revision and update of the specific Italian hygienic and sanitary regulations.