Cytomegalovirus infection in Systemic Lupus Erythematosus: report of four cases challenging the management of the disease, and literature review.

Cytomegalovirus (CMV) is particularly dangerous in systemic lupus erythematosus (SLE), being a problem both for the differential diagnosis with disease flare and for the management of SLE flare with immunosuppressive drugs. We report on four cases of SLE with concomitant CMV infection, having some common clinical and laboratory characteristics. Our data suggest that lupus patients presenting with symptoms such as fever, diarrhea, and respiratory symptoms, alone or in combination, and laboratory evidence of leukopenia, elevated transaminases, and hyponatremia, especially in the setting of recent immunosuppressive treatments, should be screened for CMV.

Tetanus immunity in construction workers in Italy.

BACKGROUND: Tetanus is a serious vaccine-preventable disease that remains a significant health risk in certain occupations. Since 2006, Italy has reported the highest number of cases in Europe. Some professions, such as construction workers, are more exposed to tetanus. AIMS: To evaluate tetanus immunity status and associated factors in construction workers in Italy. METHODS: A cross-sectional study of construction workers attending for periodic occupational health surveillance at one site in Italy between September 2011 and January 2013. Serum tetanus antitoxin levels were measured and analysed according to demographic and clinical variables. RESULTS: All 5275 workers attending for health surveillance between September 2011 and January 2013 agreed to participate. Protective tetanus antitoxin levels (>0.1 IU/ml) were found in 4116 workers (78%). Multivariate logistic regression analysis suggested that the following risk factors were significantly associated with inadequate immunization status: older age (age >58 years, odds ratio [OR] 1.78, 95% confidence intervals [CIs] 1.76-1.84), poor education (no formal education: OR 3.74, 95% CI: 3.69-3.78), unskilled work tasks (OR 2.71, 95% CI: 2.67-2.77) and country of origin (Egypt: OR 1.72, 95% CI: 1.67-1.77; Morocco: OR 1.69, 95% CI: 1.62-1.76). CONCLUSIONS: In this study, a significant proportion of construction workers in Italy were not adequately immunized against tetanus, as required by Italian law. Occupational health professionals should promote and implement vaccination campaigns, especially among migrant workers, for public health and legal reasons.

Influence of night-shift and napping at work on urinary melatonin, 17-ß-estradiol and clock gene expression in pre-menopausal nurses.

Night-workers experience disruption of the sleep-wake cycle and light at night which may increase breast cancer risk by suppressing the nocturnal melatonin surge, resulting in higher levels of circulating estrogens. Night-work may also deregulate peripheral clock genes which have been found to be altered in breast cancer. This study investigated urinary 6-sulfatoxymelatonin (aMT6s), serum 17-beta-estradiol levels in premenopausal shift nurses at the end of the night-shift compared to a control group of daytime nurses. Peripheral clock gene expression in lymphocytes were also investigated. All participants were sampled in the follicular phase of the menstrual cycle. The effect of nurses’ ability to take a short nap during the night-shift was also explored. The shift-work group had significantly lower aMT6s levels than daytime nurses independently of a nap. Night-shift napping significantly influences 17-beta-estradiol levels resulting in higher outcomes in nurses who do not take a nap compared to napping group and daytime workers. Peripheral clock genes expression investigated was not significantly different among the groups. Our findings suggest that shift nurses experience changes in aMT6s levels after a night-shift. Napping habits influence 17-beta-estradiol levels at the end of a night-shift. These findings might be related to the increased cancer risk reported in night-shift workers and suggest that a short nap during night-shifts may exert a positive effect.

[Sinonasal carcinoma and exposure to wood and leather dust: analysis of 36 cases]. / Neoplasie naso-sinusali da esposizione occupazionale a polveri di legno e cuoio: analisi retrospettiva di 36 casi.

In order to define the best strategies of prevention and diagnosis of sinonasal cancer, the aim of our study was the investigation of the etiological and prognostic factors related to 36 cases. The enrolled cases were composed mostly of men working in the footwear industry, with a mean age of 63.7 years and mean exposure of 34.6 years. The period between the start of exposure and the appearance of the neoplasm was of 44.6 years, the time between the onset of symptoms and diagnosis was of 10.8 months. Our results suggest that a diagnosis within 6 months after the onset of symptoms is associated with a lower tumor stage, a better survival and to a lower rate of recurrence. Nasal obstruction (58.3%) and epistaxis (52.7%) are the main initial symptoms. In order to obtain an early diagnosis, in addition to periodic clinical controls, a proper information of workers is required.

Pesticide exposure and gender discrepancy in breast cancer.

OBJECTIVE: It is biologically plausible that occupational and environmental pesticide exposure may contribute to breast cancer risk. Persistent chemical compounds, such as pesticides, tend to be lipophilic and are detected in human breast milk and adipose tissue. Therefore, the present systematic review aims to clarify the gender difference in breast cancer concerning pesticide exposure. MATERIALS AND METHODS: A total of 70 studies satisfied the inclusion criteria and were included in the systematic review. RESULTS: From the studies analyzed, it was observed that exposure to pesticides could be a risk factor for breast cancer in women, in particular in young women and in women who experienced menarche at a young age. In contrast, no association was found for breast cancer in men. Female breast cancer is correlated with estrogen receptor-negative tumor characteristics. Breast cancer in men was no correlated with pesticide exposure. CONCLUSIONS: Breast cancer in women has been linked to estrogen receptor positivity, but this positivity appears to be inversely related to fertility. The estrogen-like effects of organochlorine pesticides could be the cause of the observed gender differences.

[Biological risk and health care workers: analysis of the effects of work chronobiology on the immune system]. / Rischio biologico ed operatori sanitari: analisi dell'interferenza tra cronobiologia lavorativa e sistema immunitario.

BACKGROUND: Healthcare workers may be exposed to a variety of biological hazards. Although many studies have shown that some immunological alterations were related to work stress and sleep disorders, few studies investigated effects of shiftwork on the immunological system. OBJECTIVES: The aim of the study was to compare the immune status of a group of nurses on shiftwork with that of nurses working only day shifts. METHODS: A total of 138 nurses were evaluated at baseline and after a year of follow-up, via tests for perceived stress, daytime sleepiness, number of lymphocytes and subpopulation of CD3+, CD4+, CD8+-CD57+, CD19+ and CD56+, cytotoxic activity and lympho-prolferative response of NK cells, serum concentrations of IL-1beta, IL-6, INFgamma and TNFalpha. RESULTS AND CONCLUSION: No significant alterations of any of the studied parameters were found both at baseline and after a year of follow-up. The biological hazards for nurses do not seem to be increased by shiftwork.

[Role of waist circumference in the diagnosis of metabolic syndrome and assessment of cardiovascular risk in shift workers]. / Importanza della circonferenza vita per la diagnosi di sindrome metabolica e per la valutazione del rischio cardiovascolare nei lavoratori turnisti.

BACKGROUND: Shift work is associated with coronary heart disease (CHD). Metabolic syndrome (MS) is associated with an increased risk of cardiovascular disease (CVD). An association between shift work and MS has been reported in some studies. OBJECTIVE: The purpose of this study was to compare the criteria of the National Cholesterol Education Panel (NCEP), revised NCEP (NCPEP-R) and International Diabetes Federation (IDF) metabolic syndrome criteria for the diagnosis of MS, also to explore how metabolic risk factors for CVD differ between shift workers and day workers in a cohort of Italian workers. METHODS: The study population consisted of 552 workers (361 men, 191 women; mean age 40.4 years) and included 262 healthcare providers (130 rotating shift nurses and 132 day nurses), 204 forestry workers and 86 factory workers. Fasting blood sugar level, HDL-cholesterol, triglycerides, blood pressure, and waist circumference were measured. RESULTS: Healthcare providers had greater waist circumference (p< 0.01), serum triglycerides (p< 0.01) and fasting plasma glucose (p< 0.001) compare with the other worker categories. In comparison with day workers, rotating shift nurses had greater waist circumference (p<0.001), higher serum triglycerides (p< 0. 001) and fasting plasma glucose (p< 0.05), and lower concentrations of HDL cholesterol (p<0.01) The prevalence of MS according to NCEP criteria was 8.3%, according to NCEP-R criteria 9.3% and 12% according to IDF criteria. No significant association between MS and shift work was found. Abdominal obesity and high serum triglycerides was significantly associated with shift work after adjusting for age, sex, smoking, alcohol consumption and job seniority, with an OR of 2.74; 95% CI: 1.43-5.26 for high serum triglycerides and an OR of 1.81; 95% CI: 1.0-3.2 for abdominal obesity assessed according to IDF criteria. No significant association with NCEP and NCEP-R criteria was observed. CONCLUSIONS: The data show greater prevalence of cardiovascular risk factors among healthcare providers. Shift work was significantly associated with high triglycerides and abdominal obesity using IDF criteria. Measurement of waist circumference is a simple and non-invasive method to use in the evaluation of metabolic risk factor for CVD.

[LaboRisCh: an algorithm for assessment of health risks due to chemicals in research laboratories and similar workplaces]. / LaboRisCh: un algoritmo per la valutazione dei rischi per la salute da agenti chimici nei laboratori di ricerca e negli ambienti di lavoro affini.

BACKGROUND: Chemical risk assessment in research laboratories is complicated by factors such as the large number of agents to be considered, each present in small quantities, and the very short and erratic periods of exposure, all of which make reliable environmental and biological monitoring particularly difficult and at times impossible. In such environments, a preliminary evaluation procedure based on algorithms would be useful to establish the hazard potential of a given situation and to guide the appropriate intervention. OBJECTIVES: The LaboRisCh model was expressly designed to assess the health risk due to chemicals in research laboratories and similar workplaces. METHODS: The model is based on the calculation of the value of a synthetic single risk index for each substance and compound found in a laboratory and, subsequently, of a further synthetic single risk index for the whole laboratory or, where required, a section thereof. This makes LaboRisCh a compromise between need for information, ease of use, and resources required for the assessment. The risk index includes several items, chiefly the physical and chemical properties, intrinsic hazard potential, amount, dilution, and time of exposure to each agent; waste management; possible interactions; presence and efficiency of collective and individual protection devices, and staff training in good laboratory practices. The value of the synthetic single index corresponds to one of three areas: no risk (green), possible risk (yellow), and certain risk (red). CONCLUSIONS: Preliminary data confirm the model. LaboRisCh appears to be a reliable method for chemical risk assessment in research laboratories and similar workplaces.

Effect of lead on the levels of some immunoregulatory cytokines in occupationally exposed workers.

Lead (Pb) may affect humoral and cellular immunity, acting on lymphocytes as well as on granulocytes and monocytes. Cytokines and nitric oxide (NO) play a central role in the immune balance. In this study, plasma levels of nitrites and nitrates (NOx), IL2, IL4, IL6, IL10, TNF-alpha and INF-gamma, were measured in healthy workers with very low (Pb-B=3.2-18.0 microg/dL) and low (Pb-B=9.1-46.0 microg/dL) Pb-exposure compared to non-exposed workers. Low Pb-exposed workers (Pb-B=9.1 -46.0 microg/ dL) were found to have significantly higher plasma IL-10 levels, and tendentially higher plasma TNF-alpha levels compared to non-exposed workers. This is the first report of a significant increase of plasma IL-10 levels in Pb-exposed workers. Plasma IL-10 increase was influenced by blood Pb levels even after correction for main confounding factors. No difference was found in plasma NOx levels between Pb-exposed and non-exposed workers, which is in agreement with previous findings exclusively regarding groups in the general population. Low Pb-exposure can induce an increase of pro-inflammatory cytokines, such as TNF-alpha, with a consequent increase of other cytokines, such as IL-10, considered a T cell cross-regulatory factor, suggesting possible interference of Pb in the system of immunophlogosis.

[Report on the incidence of accidents and occupational diseases in the sector of waste disposal]. / Rapporto sulla frequenza degli infortuni e delle malattie professionali nel settore smaltimento dei rifiuti.

Waste management is continuously evolving, moreover, lack of resources and environmental hygiene issues have given more importance to recycling, establishing the basis of an increased risk in these workers. The aim of this study was to provide a description of occupational health of Italian waste workers in order to highlight key points for ad hoc interventions. Data about injuries and professional disease were extracted from the Italian National Labour Insurance Institute (INAIL) Waste work is a well-known cause of occupational accidents, however occupational disease appear to be less-known with many "unclassified" events. While new researches are needed in order to clarify these emerging issues, education could be the key to assure the waste workers health safety.

[Body mass index in shift workers: relation to diet and physical activity]. / BMI nei lavoratori a turni in relazione alle abitudini alimentari ed all'attività fisica.

UNLABELLED: Many studies investigated adverse effects of rotating shift work, deriving from modifications of circadian rhythms and alimentary behaviours. This may cause the disregulation of glycolipidic metabolism and of insulin secretion, and the development of central obesity. We conducted the present study in order to assess the differences in body mass index (BMI) between day and shift workers, in relation to diet quality and physical activity. DESIGN AND METHODS: The study included 341 male subjects (165 day workers and 176 shift workers). Body weight, height, BMI, waist and hip circumferences were measured. Physical activity and diet quality were assessed by self-reported questionnaires. RESULTS: Shift workers had higher BMI than day workers (27.6 +/- 3.9 vs 26.7 +/- 3.6), and this correlation persisted after adjustment for age. The diet quality was better in shift workers and the level of physical activity was similar in the two groups. DISCUSSION: The results of this study indicate that shift work is an independent risk factors in the development of overweight and central obesity. In fact, although the diet quality was even better in shift workers, and the level of physical activity was similar between day and shift workers, we found that shift workers had higher BMI.

[Mercury toxicity: trace element interactions and detoxification activity by L-arginine]. / Tossicità del mercurio: interazione con gli elementi essenziali in tracce e ruolo della L-arginina nel processo di detossificazione.

Mercury (Hg) exposure makes happen disease to humans and animals spreading in all body compartments, especially in liver and kidney. In these ones, copper, zinc, manganese and iron were investigated to assess perturbation of essential metals' homeostasis due to Hg chronic intoxication. Because L-arginine, is able to induce beneficial influence on immunologic functions on mice intoxicated with Hg, we also studied the efficiency of detoxification process before and after treatment with this aminoacid. Adding L-arginine to diet of the intoxicated mice we achieved a good restoration to normal homeostatic conditions.

[Low back pain in VDT operators: importance of sports activities]. / Disturbi muscoloscheletrici lombari in addetti al VDT: influenza dell'attività sportiva svolta nel tempo libero.

Video display terminal (VDT) operators are required to maintain a sitting position for extended periods of time. This transverse study assessed the prevalence of lumbar musculoskeletal disorders (low back pain, LBP) in a population of VDT operators and related results to occupational factors and other interfering variables. Data were collected using questionnaires administered to 210 public employees. LBP was defined and evaluated using the Standardized Nordic Questionnaire. The prevalence of LBP was 58.4%; it correlated significantly with the female sex, spinal disorders, sleep disturbances and stress levels. There was a significant negative correlation with exercise and sports activities and with leisure time computer use. Multiple logistic regression adjusted for age and body mass index yielded an LBP odds ratio of 0.19 (C.I.95% 0.07-0.51) for sport-practicing subjects. At least one hour of exercise weekly was the cut-off for a significant reduction in LBP prevalence. The proportion of lumbar musculoskeletal symptoms was not significantly different in VDT operators and the general population. None of the occupational variables considered correlated with development of LBP. The occupational physician should recommend VDT operators to devote some leisure time to exercise.

[Hymenoptera stings in forestry department agents: evaluation of risk]. / Punture di imenotteri negli agenti del corpo forestale dello stato: valutazione del rischio.

BACKGROUND: In sensitized subjects Hymenoptera stings may provoke the awakening of mediated systemic reactions of I type IgE, which can sometimes be serious. Considering the type of work performed activity and the high frequency of reported hymenoptera sting episodes, a sample of 206 Forestry Department agents was surveyed who worked outside urban areas in the Marche Region. OBJECTIVES: The aim of the study was to analyse the prevalence of stings and their possible systemic reactions, as well as to evaluate the type of occupational risks involved. METHODS: A total of 206 agents were examined and questioned about the number of stings suffered during work and about the kind of subsequent skin and systemic reactions; they were then classified according to the method proposed by H.L. Mueller. RESULTS: 179 agents reported having suffered from hymenoptera stings and, of these, 53 subjects (29,6%) remembered that one episode at least occurred during work. Among 175 operators (98%), 4 had a regular reaction, with appearance of a generalized urticaria and uneasiness. In the remaining 4 agents (2%) there was a local extensive reaction, which was not associated with systemic reactions and they were all referred to allergological examination. 19 agents (10,6%) suffered more than 5 stings altogether, but none developed a systemic reaction. 87% of the subjects practised self-medication, 7% reported to the casualty department of the local hospital or to their own doctor, and 6% undertook no cure at all. CONCLUSIONS: Epidemiological studies agree in recognizing that, in the general population, the percentage of systemic reactions after one or more hymenoptera stings varies from 0,15% to 3,3%. In categories of workers occupationally at risk, the prevalence of systemic reactions varies from 4,5% to 26%. The prevalence of systemic reactions in Forestry Department agents was 2%, which is similar to the prevalence in the general population. Therefore, rather than occupational risk, there appeared to be a generic risk made more serious by working conditions for Forestry Department agents due to their possible exposure to hymenoptera stings. The occupational health physician needs to monitor these events, due to the fact that frequent exposure to stings, above all occurring within a short period of time (less than two months) favours an increase in the tendency to develop systemic reactions, with a more serious prognosis, especially when working in isolated conditions.

[Usefulness of a questionnaire and RAST in screening of health care workers allergic to latex]. / Utilità del questionario e del RAST nello screening di operatori sanitari allergici al lattice.

BACKGROUND: The prevalence of latex mediated IgE allergy in health care workers varies, according to the various studies, from 0.5% to 16. 7%. The onset of latex allergy involves aspects concerning the worker's health, the need for job transfer and possible retraining. In any case, the use of latex gloves in health care environments cannot be discarded, since they offer more efficacious protection from biological agents, compared to gloves of different materials. OBJECTIVES: Our objectives were to verify the prevalence of latex allergy in a sample of 515 health care workers and evaluate the usefulness of RAST and a questionnaire especially organized to identify potentially allergic subjects, at the same time limiting the number of false positive and false negative results. METHODS: 515 health care workers of the ASUR Zone7-Ancona local health unit accepted to answer to a questionnaire and to undergo a RAST testfor latex. Those with positive responses to the questionnaire or to RAST were later invited to undergo further allergological tests (prick and prick by prick). The questionnaire was revised according to the results obtained, thus increasing its positive predictiveness. RESULTS: Prevalence of latex allergy in our sample was 1, 7%, positive predictiveness of RAST was rather low (31.3%), but increased considerably if combined with the modified questionnaire (62.5%). The Prick by Prick test gave more specific results than the Prick test. CONCLUSIONS: The proposed questionnaire can reduce the number of false positive workers needing to undergo further allergological tests and may be usefully applied in the screening of latex mediated IgE allergy in health care workers.

[Influence of mercury on thymulin production: metallothioneins role]. / Influenza del mercurio sulla timulina. Ruolo delle metallotionine.

Occupational or environmental exposure to various metals affects human health. In particular, mercury is known to affect the immune system adversely. Metallothioneins (MTs) are low molecular weight, cysteine-rich, intracellular proteins, with high affinity for bivalent metals of which they regulate intracellular concentrations, thereby being playing a fundamental role in metal homeostasis. MTs protect cells from stress, inflammation and free radical damage and are involved in zinc homeostasis. Zinc has an important role in the immune system because it is indispensable for the activation andfunctioning of the thymic hormone, thymulin, which in turn is involved in T-lymphocyte differentiation and maturation. MTs participate in the detoxification process following acute poisoning, and are expressed in the various tissues, as well as in chronic intoxication, where continuous stress and the persistent inflammatory state induce their over-expression. The present study was undertaken to gain insights into the potential mechanisms acting on the immune system/altering the immune status in the presence of low mercury concentrations. To do this, the genic expression of MT-I and the amount of active thymulin produced by thymic endothelial cells were studied in mice exposed to different doses of mercury.

[Reduced thymulin production during occupational exposure to lead]. / Ridotta produzione di timulina in corso di esposizione professionale a piombo.

Thymulin is a thymic hormone that being activated by binding a zinc ion promotes differentiation and several functions of T lymphocytes. It has been demonstrated only in experimental animals that metallic lead (Pb) is able to cause adverse effects on thymocyte number and function. The objective of this study is to evaluate the plasmatic level of active thymulin of 58 male workers being exposed for more than one year to low lead doses with respect to 59 male never exposed workers. All these were subjected to anamnesis collection, medical examination and determination of blood lead (PbB), plasmatic lead (PbPl), plasmatic thymulin, urinary lead (PbU) and urinary zinc (ZnU) levels. The mean plasma concentration of active thymulin was significantly lower in lead exposed than in non exposed workers. Active thymulin was also significantly and negatively correlated to PbB, PbPl and PbU level and resulted to be significantly and negatively influenced by PbB. Lead exposed workers had slightly higher zinc concentration in urine than non exposed workers, increasing ZnU levels by class of PbB. It is the first time that a toxic effect of lead on plasmatic active thymulin levels is demonstrated in humans, particularly in occupationally exposed workers. This study opens perspectives for further research that would both confirm the results and verify the mechanisms of action of lead on thymulin either direct or indirect and the possible role of zinc.

A mutation in the pleckstrin homology (PH) domain of the FGD1 gene in an Italian family with faciogenital dysplasia (Aarskog-Scott syndrome).

Aarskog-Scott Syndrome (AAS) is an X-linked disorder characterised by short stature and multiple facial, limb and genital abnormalities. A gene, FGD1, altered in a patient with AAS phenotype, has been identified and found to encode a protein with homology to Rho/Rac guanine nucleotide exchange factors (Rho/Rac GEF). However, since this original report on identification of a mutated FGD1 gene in an AAS patient, no additional mutations in the FGD1 gene have been described. We analysed 13 independent patients with clinical diagnosis of AAS. One patient presented a mutation that results in a nucleotide change in exon 10 of the FGD1 gene (G2559>A) substituting a Gln for Arg in position 610. The mutation was found to segregate with the AAS phenotype in affected males and carrier females in the family of this patient. Interestingly, Arg-610 is located within one of the two pleckstrin homology (PH) domains of the FGD1 gene and it corresponds to a highly conserved residue which has been involved in InsP binding in PH domains of other proteins. The same residue is often mutated in the Bruton's tyrosine kinase (Btk) gene in patients with an X-linked agammaglobulinemia. The Arg610Gln mutation represents the first case of a mutation in the PH domain of the FGD1 gene and additional evidence that mutations in PH domains can be associated to human diseases.

Reversibility of thymulin production impairment by L-arginine supplementation in mice exposed to inorganic mercury.

Immunotoxicological effects fo mercury on peripheral immune system are known. We had previously in vitro found that mercuric chloride inhibits thymulin production in mouse thymus cultures at concentrations as low as 10(-8) M. In this study, thymus efficiency, assessed as production of active and total thymulin, was evaluated in vivo using young mice that were injected sc every 3 days for 4 weeks with saline containing mercuric chloride at different concentrations (0 -controls-, 0.001 or 1.0 mg HgCl2/kg body weight). The results show that both the doses are able to cause a significant reduction in active and total thymulin production. Since arginine enhances immune efficiency some of the animals also received a diet supplemented with arginine in order to evaluate a possible role of arginine during mercury intoxication. The data show that arginine has a protective effect on thymic endocrine efficiency. Mice, treated with the lowest dose of mercury and receiving and arginine supplemented diet, produced active and total thymulin like mercury untreated mice. Arginine is an aminoacid which may be found in various amounts in different foods, some foods are particularly rich in arginine i.e. peanuts, stock fish. We suggest that the daily arginine intake may account for individual susceptibility to the mercury-induced immunological effects which are found in mercury occupationally exposed workers.

[Increase of TNF-alpha in subjects occupationally exposed to lead]. / Aumento del TNF-alpha in soggetti professionalmente esposti a piombo.

Occupational exposure at low doses of lead induces a significant increase of TNF-alpha plasma levels. Recently has been showed the crucial role on atherosclerosis origin of this pro-inflammatory cytokine. It is assumable a contribution of lead in atherosclerosis course in exposed subjects.