Prevalence of HBsAg and HCV antibodies in a cohort of pregnant women: the continuous survey as public health tool against pregnant and neonatal complications.

Pregnancy is a very delicate condition and different external factors can alter fetal development. Microorganisms are surely the principal ones. Several studies have shown that HBV and HCV infections could have an impact on pregnancy outcome. We performed a survey of blood samples from pregnant women in order to evaluate the presence of HBsAg and HCV antibodies. 6,896 women were tested from 2016 to 2019. 0.2% of the women in the Italian group and 2.1% among the foreigners tested positive for HBsAg, while 0.2% among the Italians and 0.7% among the foreigners were positive for HCV antibodies. Moreover, an increasing trend for both infections was observed in the foreigners. The results showed that in Italian women the positivity rates for HBV and HCV infections are very low despite the presence of both infections. A different consideration must be made for the foreigners, in whom we observed a higher positivity rate for both infections. Our findings stress the importance of a continuous surveillance of HBV and HCV markers during pregnancy and suggest that there is still much to be done in order to reduce the risk of these infections in this delicate period of a woman's life.

Hospital infection control and behaviour of operating room staff.

OBJECTIVES: Surgical site infections (SSIs) are a frequent complication of surgical procedures and one of the most common forms of hospital acquired infection (HAI). National/international guidelines and recommendations have been issued for prevention. The objective of this study was to observe the behaviour of healthcare workers engaged in surgical procedures and hence assess compliance with SSI guidelines. METHODS: An observational descriptive study was conducted at a University hospital in southern Italy. A specifically designed form was used to record the actions of the surgical team during randomly selected surgical operations. Observations comprised the use of surgical attire, the frequency of doors opening and the number of staff in the operating room. RESULTS: A total of 308 operating room personnel was observed during 402 surgical procedures: 127 surgeons (41%), 39 anaesthesiologists (13%), 62 nurses (20%) and 80 students in training (26%). 96% of the surgical team wore scrubs, 93% of health workers wore a mask and of these 78% wore it correctly in order to completely cover the nose, mouth and beard (when present), 99% wore a cap (only in 48% was the hair completely covered), 50% of the operators wore gloves, 95% wore shoes dedicated to the operating theater and 23% also wore shoe covers, 56% wore gowns, and 22% had eye protection. Furthermore, the average number of health personnel in the operating theater was 8, the doors remained closed in 261 (65%) surgical operations. CONCLUSION: As the results indicated a low adherence to international guidelines among the personnel, it is suggested that training courses should be provided to increase staff awareness on prevention and management of HAI.

The Myth of Water and Salt: From Aquaretics to Tenapanor.

The impact of water intake has been studied in several renal diseases. For example, increasing water intake is useful to prevent primary and secondary nephrolithiasis. In autosomal dominant polycystic kidney disease, arginine vasopressin (AVP) is involved in the progression of the disease, and water intake could play a therapeutic role by inhibiting the synthesis of AVP, but its efficacy is still controversial. Conversely, the use of aquaretics, which are antagonists of AVP V2 receptors, results in the reduction of the increase rate of total kidney volume with a slower decline of glomerular filtration rate. In chronic kidney disease, AVP contributes to glomerular hyperfiltration, arterial hypertension, and synthesis of renin, resulting in renal sclerosis. Increased water intake could reduce AVP activation determining a potential protective effect on the kidney, but its efficacy has not yet been clearly demonstrated. On the other side, sodium and potassium play an important role in the control of arterial blood pressure and are involved in the development and progression of chronic kidney disease. Reduction of sodium intake and increase of potassium intake determine a decrease of arterial blood pressure with a beneficial effect on the kidney; however, adherence to sodium restriction is very poor. Regarding this, sodium-hydrogen exchanger isoform 3 inhibitors may reduce sodium absorption in the gut. The most recent sodium-hydrogen exchanger isoform 3 inhibitor, known as tenapanor, reduces extracellular fluid volume, left ventricular hypertrophy, albuminuria, and blood pressure in experimental studies and increases fecal loss of sodium in humans.

Towards a Future of Personalized Vaccinology: Study on Individual Variables Influencing the Antibody Response to the COVID-19 Vaccine.

The COVID-19 pandemic has hugely impacted many different aspects of human health, and vaccination is one of the most effective weapons to manage it. However, many different factors, such as age, gender, comorbidities and lifestyles, play a role in the response to infections and vaccines. We carried out this study to evaluate the potential role played by some individual factors in the production of anti-COVID-19 antibodies in the light of personalized and future vaccinology. We conducted an observational study consisting of a retrospective phase, exploiting previous data about anti-COVID-19 antibody responses, with a prospective phase to investigate individual variables through the use of a questionnaire. The antibody response after the COVID-19 vaccination was inversely related to old age, increased BMI and the number of smoking years, while a positive correlation was found with moderate alcohol consumption and especially with circulating levels of vitamin D, as clearly shown by the multivariate regression analysis. Our study showed that a number of variables are involved in the COVID-19 vaccine antibody response. These findings are very important and can be considered in the light of a future and personalized vaccinology.

Lung Dysfunction and Chronic Kidney Disease: A Complex Network of Multiple Interactions.

Chronic kidney disease (CKD) is a progressive disease that affects > 10% of the total population worldwide or >800 million people. CKD poses a particularly heavy burden in low- and middle-income countries, which are least able to cope with its consequences. It has become one of the leading causes of death worldwide and is one of the few non-communicable diseases where the number of related deaths has increased over the last two decades. The high number of people affected, and the significant negative impact of CKD should be a reason to increase efforts to improve prevention and treatment. The interaction of lung and kidney leads to highly complex and difficult clinical scenarios. CKD significantly affects the physiology of the lung by altering fluid homeostasis, acid-base balance and vascular tone. In the lung, haemodynamic disturbances lead to the development of alterations in ventilatory control, pulmonary congestion, capillary stress failure and pulmonary vascular disease. In the kidney, haemodynamic disturbances lead to sodium and water retention and the deterioration of renal function. In this article, we would like to draw attention to the importance of harmonising the definitions of clinical events in pneumology and renal medicine. We would also like to highlight the need for pulmonary function tests in routine clinical practise for the management of patients with CKD, in order to find new concepts for pathophysiological based disease-specific management strategies.

Role of the 1st booster dose of COVID-19 vaccine in the protection against the infection: A fundamental public health tool.

Introduction: The COVID-19 pandemic is having a huge impact on human health with high morbidity and mortality rates worldwide. Healthcare Workers (HCWs) are one of the most at risk categories to contract the infection. Effective anti-COVID-19 vaccines were approved in a very short time. Making the 1st booster dose is essential to induce a good protection against the infection. Methods: We conducted a retrospective sero-epidemiological survey of already existing data concerning the antibody response of a HCWs sample vaccinated with the primary cycle and the 1st booster dose of the Pfizer-BioNTech COVID-19 mRNA vaccine and, specifically, after three weeks from the third dose of vaccination. Results: In our analysis, after the primary cycle, a 95.15% efficacy was detected. Among the non-responders, women were significantly more frequent (69.56%). Moreover, we found a significant reverse correlation between the immune response and the age of the sample, especially in women. However, the 1st booster dose completely cancelled these differences. Conclusions: Our data are perfectly in line with what has been declared by the conducted studies in terms of efficacy. However, it is important to highlight that people with only the primary cycle are at high risk to contract the COVID-19 infection. Therefore, it is necessary to not consider people vaccinated with the primary cycle completely risk-free and to stress the importance to perform the 1st booster dose.

Efficacy of COVID-19 Vaccination in People Living with HIV: A Public Health Fundamental Tool for the Protection of Patients and the Correct Management of Infection.

HIV/AIDS is considered a risk factor for increased mortality due to COVID-19. For this reason, it is essential to include this population in vaccination campaigns. Studies found that antibodies are lower in HIV+ patients than in healthy individuals. The aim of this study was to assess the immune response in a cohort of people living with HIV/AIDS (PLWH) vaccinated with COVID-19 vaccination in order to evaluate the role played by the HIV infection in the efficacy of this vaccine. We carried out a cross-sectional study in the period April-September 2021, involving a cohort of PLWH and a cohort of HIV-uninfected people as the control group. The efficacy of vaccination was high in both groups despite a slight and not significant difference between them. However, important differences were found according to the intensity of the immune response. Specifically, while in the HIV+ group almost a quarter of people had a low response, it is important to remark that the control group had only a high or intermediate response after vaccination. Our results suggest the high efficacy of the mRNA COVID-19 vaccine in PLWH and the importance to vaccinate against COVID-19 in these patients in order to increase their protection.

Clinical Evaluation of the Safety, Efficacy and Tolerability of Lanthanum Carbonate in the Management of Hyperphosphatemia in Patients with End-Stage Renal Disease.

Patients with progressive chronic kidney disease (CKD) commonly develop mineral and bone abnormalities and extraskeletal calcifications with following increased cardiovascular risk. A key pathophysiological role is played by hyperphosphatemia. Since diet and dialysis are often insufficient to control serum phosphorus levels, many patients require treatment with phosphate binders. Among them is lanthanum carbonate, an aluminum-free non-calcium-based compound. The present review summarizes the most recent literature data concerning the safety, efficacy and tolerability of lanthanum carbonate in patients with end-stage renal disease and hyperphosphatemia. The drug is taken orally as chewable tablets or powder with only minimal gastrointestinal absorption and resulting reduced risk of tissue deposition and systemic drug interactions. The dissociation of the drug in the acid environment of the upper gastrointestinal tract induces the release of lanthanum ions, which bind to dietary phosphate forming insoluble complexes then excreted in the feces. Even though there is no clear evidence that lowering serum phosphorus levels can improve patient-centered outcomes, a mortality benefit with all phosphate binders, especially non-calcium containing ones, is not excluded. Lanthanum carbonate has been suggested to decrease all-cause mortality but not cardiovascular event rate compared to other phosphate binders. It induces a lower suppression of bone turnover than calcium carbonate and calcium acetate and may improve systolic function and cardiac dimension compared to calcium carbonate. Moreover, the use of lanthanum carbonate has been associated with better nutritional status compared to other phosphate binders, lower risk for hypercalcemia than calcium-containing binders, and amelioration of mild metabolic acidosis contrary to sevelamer hydrochloride. Main adverse effects include nausea, alkaline gastric reflux, gastric deposition of lanthanum, gastrointestinal obstruction, subileus, ileus, perforation, fecal impaction, and reduction of gastrointestinal absorption of some drugs including statins, angiotensin-converting enzyme inhibitors and some antibiotics such as fluoroquinolones or tetracyclines.

Iron Infusion and Induced Hypophosphatemia: The Role of Fibroblast Growth Factor-23.

The mechanism of action of fibroblast growth factor-23 (FGF23) is becoming increasingly clearer as a result of studies that have defined its structure and pleiotropic effects. Furthermore, data are emerging on the effects exerted on this hormone by iron administration. Ten main iron formulations are recognized (with clear differences in composition and possible reactions of intolerance and anaphylaxis), which are indicated for iron deficiency anemia, including nephropathic subjects, as suggested by medical guidelines. With some types of iron formulation (especially iron carboxymaltose) a particular side effect has been observed: hypophosphatemia, mediated by FGF23. This review aims to draw attention to this correlation and the contradiction represented by the presence of both positive and negative modulation by FGF23, with the effects induced by its increase even after long-term treatment with iron formulation. However, more evidence is needed to understand the reasons for this differential stimulation.

Chlamydophila psittaci seropositivity and serum levels of soluble intercellular adhesion molecule-1 in farmers.

Chlamydophila infection is known as an occupational hazard to veterinarians, farmers, poultry workers. Serum levels of the soluble Intercellular Adhesion Molecule-1 (sIC AM-1), is associated with C. seropositivity. Since no data about IC AM-1 levels and C. psittaci infection are known, the aim of this work was to assess if chronic persistent C. psittaci infection constantly stimulates the expression of sIC AM-1, independent of the characteristic symptoms of ornithosis. C. psittaci seropositivity and serum concentrations of sIC AM-1 were investigated in 30 farmers and 20 age-matched healthy public employees as controls. Increased serum sIC AM-1 levels were found in the group of farmers exposed to infectious risk compared to controls, and the serum concentrations of sIC AM-1 was significantly correlated with a high IgG titre against C. psittaci. It is therefore possible to suggest a sIC AM-1 measurement for use as a tool to verify the development of C. psittaci chronic infection in an occupational setting.

Serologic investigation of the prevalence of Chlamydophila psittaci in occupationally-exposed subjects in eastern Sicily.

The aim of the study was to investigate the occurrence of serum antibodies to C. psittaci in workers at 8 stock farms located in a rural area of eastern Sicily. Serum samples from 188 workers and 160 controls were tested for immunoglobulin IgA, IgG and IgM direct against C. psittaci by microimmunofluorescent test (MIF). Seropositive subjects were defined as those with IgG titres of 1:16-1:256, and seronegative subjects as those whose titre was <1:16. To rule out the presence of cross reactive antibodies, testing was also performed for C. trachomatis and C. pneumoniae. A total of 28 (14.9%) subjects studied met the criteria for seropositivity to C. psittaci. Two of the 188 (1.06%) had an IgG titre of 1:32, 16 (8.51%) an IgG titre of 1: 64, 6 (3.19%) an IgG titre of 1:128 and 4 subjects (2.12%) demonstrated an antibody titre of 1:256. The high prevalence rate of C. psittaci antibodies among farmers suggests that this infection is spread in those subjects living in areas with an high percentage employed in rearing activities. The authors stress the importance of carrying out health surveillance in subjects working in close contact with animals receptive to infection, and confirm the need to adopt a serological test, such as MIF as a preventive measure for activities at risk.

Comparative Confocal and Histopathological Study of Corneal Changes in Multiple Myeloma.

PURPOSE: Corneal opacities rarely occur in multiple myeloma (MM). Our study correlates the findings of in vivo confocal microscopy (IVCM), a useful diagnostic tool, with histopathological features of corneal opacities appearing in a patient with MM. METHODS: Case report. RESULTS: A 53-year-old man developed corneal opacities in both eyes, more pronounced in the left eye. After IVCM examination, he underwent penetrating keratoplasty in the left eye, and the button was processed for light and electron microscopy and immunohistochemistry. The diagnosis of MM was made, as confirmed by the elevation of IgGk light chains. IVCM demonstrated hyperreflective areas at the epithelial level, hyperreflective keratocytes of dendritic and lamellar morphology in whole stroma, and hyperreflective endothelial cells. Histopathological examination disclosed many vacuoles in the epithelial cell cytoplasm and a homogenous granular material in the Bowman layer. In stroma, keratocytes of different shape and size, with vesicles laden with an abnormal material, were evident. In Descemet membrane, the posterior nonbanded zone had a honeycomb appearance because of the presence of many roundish spaces among wide-spaced collagen fibers. Endothelial cells demonstrated vesicles filled with a material of uneven electron density. Immunohistochemical analysis showed strong positivity for IgGk light chains in keratocytes and among stromal lamellae. CONCLUSIONS: This is the first study describing a correspondence between IVCM features and histopathological alterations observed in corneal opacities in MM. The results of this study improve the current understanding of the pictures obtained by IVCM studies.

Investigating the Role of Physical Education in Physical Activity Promotion: An Italian Multicenter Study.

BACKGROUND: Physical education (PE) can be considered an instrument for active lifestyle promotion, and PE teachers can motivate youths to continue their studies in the field of Movement Sciences (MS). METHODS: To evaluate the role of PE in higher secondary school in promoting physical activity (PA) and MS careers, previous PE experiences and current PA practice were investigated in a sample of Italian freshmen enrolled in different university degree courses. RESULTS: A total of 7033 questionnaires were completed by students from 14 universities (41.3% males, mean age 20 ± 2.76 years). Recreation seemed to be the principal aim (42.2%) pursued during PE lessons, which are based mainly on practical activities (51.7%). Of all respondents, 67.2% were satisfied with the PE received during higher secondary school, and 51.6% participated in extracurricular PA. Current practice of PA was reported by 58.1% of the sample. Extracurricular activities were associated with choice of MS curricula (odds ratio: 2.15; 95% confidence interval, 1.85-2.50) and with current practice of PA (odds ratio: 1.68, 95% confidence interval, 1.51-1.87). Geographical differences concerning lessons organization and satisfaction were registered (P < .01). CONCLUSIONS: To enhance its role in health promotion, PE teaching should be improved by increasing the time allocated to PE and by strengthening the provision of school-based extracurricular PA.

Seroprevalence and occupational risk survey for Coxiella burnetii among exposed workers in Sicily, Southern Italy.

OBJECTIVES: The aim of this survey was to assess the seroprevalence of antibodies against Coxiella burnetii (C. burnetii) in subjects at risk of exposure in Sicily, Southern Italy. MATERIAL AND METHODS: Prevalence of IgG antibodies to C. burnetii phase II antigens was evaluated by ELISA in a group of 140 workers at risk of exposure (38 veterinarians, 38 slaughterhouse workers, 44 livestock handlers, 20 laboratory and technical personnel) included in a medical surveillance program and in 42 control subjects. Positive samples were classified as suggestive of prior exposure to C. burnetii. RESULTS: Antibodies against C. burnetii were detected in 88 out of 140 (62.9%) exposed workers and in 6 out of 42 (14.3%) subjects of the control group. The variables evaluated did not seem to have a significant effect on seropositivity to Coxiella with the exception of symptoms in the last 6 months preceding the survey. CONCLUSIONS: Our study demonstrated a high seroprevalence of C. burnetii in the group of exposed workers in comparison to non-exposed subjects of the control group. Clinical illness appears to be rare; nevertheless, physicians should consider Q fever in patients with compatible symptoms and occupational exposure to animals and their products. As aerosols represent the main route of infection in animals and humans, these workers are strongly advised to wear respiratory masks. In addition, occupational physicians should consider routine serologic evaluation and vaccination of occupationally exposed workers.

Congenital rubella syndrome and immunity status of immigrant women living in southern Italy: a cross-sectional, seroepidemiological investigation.

OBJECTIVES: A National Programme to eliminate Measles and Congenital Rubella was implemented in Italy in 2003. It aimed to achieve elimination by 2010 in line with the targets set by the World Health Organization (WHO) European Region. The aim of this study was to determine the prevalence of rubella antibodies in samples of immigrant women living in southern Italy. METHOD: A seroepidemiologic study was conducted from 1 January 2008 to June 30 2009. 489 immigrant women resident in Messina were enrolled in the study. The detection of rubella antibodies was performed using a microparticle enzyme immunoassay. A questionnaire was used to collect demographic data including age, country of origin, educational level and knowledge about rubella. RESULTS: The results of the seroepidemiological survey to detect rubella antibodies showed an overall seropositivity rate of 82.2%. Generally, knowledge about rubella and congenital rubella syndrome was lacking. CONCLUSION: Many immigrants are susceptible to rubella and may benefit from vaccination programmes. Additional catch-up vaccination strategies are urgently needed to eliminate the risk of congenital rubella syndrome for future generations.

Prevalence of serum anti-rubella virus antibodies among pregnant women in southern Italy.

OBJECTIVE: To determine the prevalence of anti-rubella virus antibodies and the level of knowledge about congenital rubella syndrome (CRS) among pregnant women living in southern Italy. METHODS: A seroepidemiologic study was conducted between July 1, 2006, and December 31, 2007. Five-hundred women resident in Messina were enrolled in the study; the participants were in the 4th to 39th week of pregnancy. Anti-rubella virus antibodies were assayed using a microparticle enzyme immunoassay. Demographic details, vaccination history, and participants' knowledge of the potential risks of rubella infection during pregnancy were assessed via questionnaire. RESULTS: On the basis of the questionnaire results, 70.4% of women were classed as immune to rubella virus infection; however, the prevalence of IgG anti-rubella virus antibodies measured in the participants' serum was 85.8%. Although 55.2% of women had undergone pre-pregnancy rubella screening, only 81 participants reported that they had been vaccinated before becoming pregnant. The participants' general knowledge about CRS was poor, as was their understanding of the importance of undergoing screening. CONCLUSION: The number of women at risk of rubella infection fell short of the national target set for elimination of CRS. Increased involvement and collaboration by all healthcare workers are, therefore, required to disseminate the information necessary to prevent CRS.