The history of polio vaccination with "Sabin's OPV" 60 years after its introduction in Italy: an unforgivable "delay".

In the spring of 1964, polio vaccination with the oral vaccine developed by Albert Sabin began in Italy. Polio was feared in the world and in Italy. Thus, between 1957 and the beginning of 1958, Italian children began receiving the "Salk vaccine", though the results were not particularly convincing. In July 1960, the international scientific community was able to verify the data from the mass testing of the Sabin vaccine. It became clear that the OPV, could prevent the virus from multiplying, thereby providing greater protection and determining the eradication of the disease. In 1960 over 70 million people in the USSR alone had already received the oral vaccine and mass vaccination in the USA would start in March 1961. However, in Italy there was no similar initiative; only later the new vaccine was accepted but was not made compulsory at the beginning. As a result of the commission's report, registration of the "Polioral" vaccine, was authorized in September 1962 but the sale of the vaccine was not authorized until November 1963. At the beginning of 1964, the production of "Polioral" started and the product was marketed and on the 1 st of March 1964, anti-polio vaccination with the "Sabin anti-polio vaccine" also began in Italy. This manuscript focuses on a crucial issue about a historical delay for public health and it points out as the preparation and diffusion of the Sabin polio vaccine demonstrates that decisions regarding health treatments, and specifically vaccination campaigns, must be based exclusively on the results of clinical studies and on independent evaluation by the scientific community. This process ensures trust in vaccines, adequate protection of public health andcitizens' well-being.

A historical and palaeopathological perspective on cancer.

Cancer is often wrongly considered to be a modern disease in many popular medical venues. Cancers have been known to humanity since ancient times. In fact, its antiquity can be identified through the application of palaeopathological methodologies. The present perspective demonstrates by means of a historical and palaeopathological analysis how oncological manifestations were present long before the emergence of anatomically modern humans and addresses the epidemiological transition from ancient times to the contemporary world. The final section of the article examines breast cancer and its identification in ancient human remains.

"The blinding disease". The history of trachoma in Italians between the 19th and 20th centuries: colonial or national blindness?

Trachoma is one of the oldest known causes of blindness in humans and it is caused by the intracellular Gram-negative bacterium Chlamydia trachomatis serovars A, B, Ba and C. Its transmission has historically been related to poorness, overcrowded housing and scarce hygiene. We have traced the history of trachoma in Italy in the 19th and 20th centuries, among people living in Italy, those who immigrated to America and the population in the colonies, with a focus on Libya (1912-1943). Trachoma knowledge and perception in Italy and in its colonies was ambiguous during the 19th and 20th centuries. Trachoma was responsible for a great morbidity on both sides of the Mediterranean, in Italy as well as in Libya. Trachoma is still one of the leading infectious causes of preventable blindness worldwide and it was widespread in Italy and the Italian colonies in the first half of the last century.

Balto and Togo during the cold winter of Alaska (1925): the two canine heroes in the fight against diphtheria.

In recent years, diphtheria has re-emerged in areas with inadequate vaccination coverage, and Europe has not been spared with several cases among migrants. Diphtheria is a potentially fatal infection caused mainly by toxigenic strains of Corynebacterium diphtheriae. Due to the high mortality rate, especially among young children, the fight against diphtheria is considered one of the first conquests of immunization. In the history of medicine, there is a unique case of an unconventional response to a diphtheria outbreak in which sled dogs were used to overcome the supply difficulties of diphtheria antitoxin. The mass media followed the medical response to the outbreak and raised audience awareness of public health issues. The facts of Nome, Alaska, in 1925 can serve as a catalyst to rethink conventional responses to diphtheria outbreaks in low-income countries today and promote mass media awareness of public health importance.

Prevalence of Non-alcoholic Fatty Liver Disease in Iran: A Systematic Review and Meta-analysis.

Background: Non-alcoholic fatty liver disease (NAFLD) has a benign course in several patients; however, a serious form of this disease can turn into liver failure, liver cirrhosis, and hepatocellular carcinoma. Aim: This study aims to estimate the prevalence of NAFLD in Iran. Method: We searched the following databases from January 2000 to December 2022: Scopus, Pubmed/Medline, Embase, Web of Sciences, the Cochrane Library, and Google Scholar also a number of Iranian databases, namely MagIran, SID, and Elmnet. Additionally, the quality of the included studies was evaluated through the Newcastle-Ottawa Scale. We estimated heterogeneity between studies using the I2 statistic. Furthermore, we performed a synthesis of prevalence estimates through the random-effects DerSimonian and Laird model across the included studies with a 95% confidence interval. To assess the publication bias, we also used Egger's test. Results: Thirty-one studies were eligible for inclusion. The overall number of participants in the present study was 41,971. The overall prevalence of NAFLD in Iran was 33% [CI: 27-37%], with I2 = 99.7% (P < 0.01). The prevalence was 35% [CI: 27-43%] and 37% [CI: 27-47%] in males and females, respectively. We used Egger's test, and no significant publication bias was identified in the overall prevalence (P = 0.45). Conclusion: According to the results of this study, the prevalence of NAFLD in Iran is not only high but alsoa growing trend. Effective strategies for changing lifestyles, changing eating habits, and encouraging physical activities among Iranians are recommended. Also, providing screening tests, especially among high-risk groups, has a significant effect on early diagnosis and NAFLD control.

The specter of cholera in Libya and North Africa: Natural disasters and anthropization threaten human health during recent years.

Introduction: According to data from the World Health Organization (WHO), in the last year cholera has re-emerged in various areas of the planet, particularly in Africa. The resurgence of this disease is closely linked to poor hygiene, which is sometimes the result of wars or environmental disasters, as in Lebanon and Syria since autumn 2022 and today in Libya. Discussion: The spread of cholera is chiefly caused by the presence of contaminated water, in environments with inadequate hygiene and sanitation. Another cause, however, is the lack of access to adequate vaccination and treatment campaigns. Method: In this short paper, the authors highlight the possibility of a resurgence of epidemic cholera in Libya, especially in light of the consequences of the devastating cyclone Daniel and the simultaneous collapse of two dams upstream of the city of Derna. They also highlight the concern that cholera and other infectious diseases may also spread in Morocco, which was hit by a severe earthquake on 8 September last. The focus of the paper is the awareness that the spread of epidemic diseases is very often linked to human actions, which may trigger or exacerbate the effects of natural disasters. Conclusions: Since these events have devastating effects both on the environment and on people and their psychophysical balance, it is evident that we need to devote greater attention to the health of the planet, to which the health and survival of the human species is strictly and inextricably linked. Indeed, disasters related to phenomena of anthropization facilitate the spread of infectious diseases, placing a heavy burden on local and global health organizations and the health of entire populations. A change of course is therefore essential, in that human actions must be aimed at limiting rather than aggravating the spread of diseases.

The history of pertussis: from an ancient scourge to a contemporary health burden.

The present article offers a historical overview on pertussis (whooping cough) by analysing the ancient epidemic manifestations of the disease and the path towards the discovery of an effective vaccine against it. The original mentions of pertussis are examined with reference to Mediaeval Afghanistan and the famous AD 1578 Paris epidemic described by the French physician Guillaume de Baillou. The historical data are then matched with information derived from analyses of phylogenetic trees of B. pertussis. Finally, this article also highlights some recent challenges posed to public health by this infectious disease.

The health of mankind and the health of the planet in a historical-ethical perspective: an inseparable relationship and a single destiny.

Recent years have seen increasingly severe natural disasters, the consequences of which have been catastrophic. Clearly, our global environment is undergoing major changes. The climate is becoming deranged and pollution on a global scale afflicts air, water, and land. We are faced with an unprecedented shortage of cultivable land and fresh water for drinking, irrigation, and livestock farming, while our marine systems are breaking down. These environmental changes have a very high anthropogenic component; they are induced by human activities that are potentially dangerous for both the environment and human life. Moreover, not only do they have an enormous impact on the environments in which we live and on our way of life, they also have harmful effects on our health. Indeed, we must understand that our body - as Hippocrates explained long ago - is a system that constantly interacts with the surrounding environment.

Mpox: "the stigma is as dangerous as the virus". Historical, social, ethical issues and future forthcoming.

Objectives: The authors aim to show the possibility of stigma that hits affected Mpox patients because of the statements of society involving their sexual sphere. Introduction: 23 July 2022, the Director-General of the WHO, Thedos Ghebreyesus, issued an international public health alert regarding cases of Mpox (formerly known as Monkeypox). Although Mpox has been present in an endemic form for years in some Central African countries, the spread of the disease outside Africa has aroused considerable alarm in populations already sorely afflicted by the COVID-19 pandemic. Aside from the data, what is striking is that Mpox, like other infectious diseases, seems to have become a problem only when it began to cross the borders of Africa. Some may justify this attitude simply by ascribing it to the fear of an epidemic outside the areas where the virus is endemic. However, in such cases, and especially after the COVID-19 experience, other factors are also involved: lack of information and, even more so, the human capacity to utilise diseases to reinforce arguments against the tendencies, inclinations, orientations and behaviours of some social groups. Such information, albeit basically correct, is nevertheless incomplete. Moreover, it tends to prompt a view of this disease that may give rise to highly dangerous and embarrassing situations, engendering the risk of repeating the error that was made about AIDS. Mpox is the latest in a series of epidemics that have struck humanity in the space of very few years. Material and methods: Setting and partecipants: people and social groups who, due to sexual orientations and behaviours, are considered to be at risk of being infected with Mpox. Main outcomes measures: - outcomes directly related to mental health of Mpox patients: anxiety, fear and depression, emotional difficulties, feelings of loneliness and isolation; - well-being outcomes of people with Mpox; - risk of not being able to reduce the epidemic among those groups don't feel as though they belong to LGBTQ and therefore do not implement any kind of prevention. Results: Limit the contagion from Mpox through specific health and communication campaigns. Remove any stigma related to Mpox disease. Conclusions: In the face of this disease, it is absolutely essential that we do not needlessly isolate groups of people by feeding stigma, prejudice and discrimination, which can have devastating effects not only on individuals but also on society as a whole. As the full inclusion of persons of LGBTQ community is probably still a long way off, we must surely wonder when we will be ready enough to achieve the important objective of equality for all.

History of primary health care in Iran.

Background: The history of the primary healthcare system in Iran portrays a journey of strategic development and implementation that has resulted in significant advancements in healthcare access and overall population well-being. Starting in the early 1980s, Iran embarked on a comprehensive approach to health care delivery prioritizing universal access, equity, and community participation. Introduction: The foundation of this system was established during the Alma-Ata Conference in 1978, which placed a strong emphasis on the role of primary health care in attaining health for all.Iran's unwavering commitment to this approach led to the creation of an extensive network of rural and urban health centers designed to offer essential health services and preventive care to all citizens. Discussion: Over the years, the expansion of Iran's primary healthcare system has yielded noteworthy accomplishments. Maternal and child mortality rates have seen substantial declines, attributed to improved access to maternal care and immunization services. The effectiveness of the system in reaching diverse populations has been enhanced through community engagement and the integration of traditional medicine. Furthermore, Iran's focus on health education and disease prevention has resulted in heightened public awareness and the adoption of healthier lifestyles. Despite these achievements, challenges continue to persist. Disparities in the quality and accessibility of services between urban and rural areas remain a concern. Moreover, the ongoing necessity for infrastructure development, training of the health workforce, and efficient resource allocation underscore the continuous efforts required to strengthen the primary healthcare system. Conclusions: The history of Iran's primary health care system is marked by progress and achievements, underscored by an unwavering commitment to providing comprehensive, community-based care. Iran's journey serves as an exemplary model, highlighting the positive impact of prioritizing primary health care in achieving better health outcomes for its population. As Iran continues to evolve its health system, addressing challenges and building upon successes, the history of its primary health care system serves as a valuable lesson in the pursuit of accessible and equitable health care for all.

Analysis of death risk factors among COVID-19 patients in Yazd, Iran: A case-cohort study.

Background: The COVID-19 epidemic control has become a global challenge and many contributing variables are still unknown to policymakers. This case-cohort study was conducted to investigate the risk factors of mortality in COVID-19 patients. Methods: This case-cohort study was conducted on 956 samples in Ardakan and Meybod counties, Yazd Province, between February 20 and May 20, 2020. The data collection tool was a researcher-made questionnaire. Data analysis was done using descriptive statistics and paired t-test, chi-square, and logistic regression analysis. Results: Of a total cohort population of 993 in Ardakan and Meybod counties, 435 were assigned to the control group and 521 were assigned to the case group. The results of outcome analysis showed that 14.4% of the patients in the case group and 11.5% of the patients in the control group died. According to the results of logistic regression analysis in COVID-19 patients, each one-year increase in age increased the risk of mortality by 6% (HR = 1.06, p < 0.001), each one-day increase in the hospital stay increased the risk of death by 8% (HR = 1.08, p < 0.001). Moreover, the presence of cardiovascular disease, chronic neurological disease, and chronic pulmonary disease increased the risk of death. The patients who underwent mechanical ventilation had 85% less chance of survival (HR = 0.15, p < 0.001). Conclusions: The results showed a higher mortality rate in the elderly patients as well as those with underlying diseases. Attention should be paid to at-risk and elderly patients in terms of ensuring a healthy diet, improving their self-care practices, and providing long-term medical and healthcare facilities.

Adults' perceived health promotion needs in the prediabetes stage: a meta-synthesis study.

Introduction: One of the methods to promote pre-diabetic patients' adherence to preventive behaviors and improving their lifestyle is to pay attention to their needs in the designed educational programs. Therefore, this study was conducted with the aim of identifying the needs of individuals with prediabetes. Methodology: Three databases, including ISI/Web of Sciences, PubMed, Scopus were searched without time limitation until August 2022. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. This study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines and to achieve the research goal, Sandelowski and Barroso's seven-step meta-synthesis method (2007) was used. Thematic synthesis was used to analyses the data. Results: Out of the 1934 studies obtained, 34 studies were finally examined and 805 codes were recorded based on the extracted data. Through synthesizing and analyzing the primary studies, 8 main themes were extracted regarding individuals' needs in the prediabetes stage: Information needs, Cultural needs, psychological needs, Social support needs, Education needs, Financial needs, Service needs and Skill needs. Discussion and Conclusions: The perceived needs and their types in each of the dimensions in detail can be a proper guide for designing educational programs and various interventions to control the prediabetes condition, leading to a reduction in the prevalence of type 2 diabetes in the society.

The effect of diabetes training through social networks on metabolic control of individuals with type 2 diabetes; a randomized controlled trial.

Background: Due to spread of smart phones, opportunity to train patients with diabetes and communicate with them using social media is rising. Aim of this study was to evaluate the effect of training through two popular social networks in Iran ("Telegram" and "Soroush") and the metabolic control of people with Type 2 diabetes. Methods: In this randomized controlled trial, we recruited 134 patients with type 2 diabetes, which randomly allocated into two groups: the intervention and the control group on a 1:1 basis. The studied tools included demographic information and awareness of diabetes and international physical activity questionnaires. The intervention comprised a training package that delivered to the intervention group via social media for 45 days. The primary outcome measures included awareness of diabetes management and physical activity level while secondary outcome measures were HbA1c and lipid profile. Results: Social network training led to the increase of the patients' awareness (44.31 ± 2.78 to 46.88 ± 2.25 in intervention group vs 44.14 ± 3.85 to 44.41 ± 3.87 in control group) and physical activities level (23.64 ± 8.46 to 31.68 ± 7.12 in intervention group vs 26.20 ± 9.39 to 30.20 ± 8.11 in control group) (p-value < 0.001). Besides, LDL and HDL levels, and HbA1c (8.19 ± 2.10 to 8.05 ± 1.96 in intervention group vs. 7.53 ± 1.67 to 7.45 ± 1.34 in control group) decreased significantly (p-value < 0.05). Conclusions: Changes in lifestyle and challenges of the patients' attendance in diabetes training sessions, declared that use of social networks can be useful to train diabetes patients remotely, and it is feasible to send training messages to help them improve their diabetes care.

Understanding conflicts of interest in rational drug prescription in a developing country: A stakeholder analysis, healthcare guidelines and ethical public health issues.

Background: Rational drug prescription (RDP) is one of the main components of the healthcare systems. Irrational prescribing can bring about numerous negative consequences for the patients and governmental agencies. This study aims to analyze the involvement of stakeholders in rational drug prescribing, their position (opponent or proponent), and the rationale behind it. Methods: This was a qualitative study conducted in 2019. Semi-structured face-to-face interviews were conducted with 40 stakeholders. Purposive and snowball sampling techniques with maximum heterogeneity were adopted to select the interviewees. Data was analyzed by MAXQDA software using thematic approach. Results: Iranian Food and Drug Administration employs the highest authority on the rational prescribing policy. Although the Ministry of Health and Medical Education, the Social Security Organization as one of the main health insurance organizations, pharmaceutical companies, and the Medical Council of the Islamic Republic of Iran, are among agencies that have great authority to improve rational prescribing, they fail to act professionally as they have conflicting interests. Remarkably, the Iran Food and Drug Administration, insurance organizations, family physicians, and patients, highly support the rational prescribing policy while the pharmaceutical companies display the least support for it. Conclusions: To make the prescription and using drugs more rational, policy makers should focus on different sources of conflicts of interest that different actors have. They should devise legal, behavior and financial policies accordingly to lessen or at least neutralize these conflicting interests, otherwise achieving RDP would be impossible in short and long terms.

Simultaneous cytomegalovirus uveitis and HIV retinopathy / Uveíte por citomegalovírus e retinopatia por HIV simultâneas

ABSTRACT A 41 year-old man presented with unilateral vision loss for a week and constitutional symptoms for 3 months. Ophthalmic evaluation revealed cotton wool spots on the right eye and widespread retinal necrosis and hemorrhage on the left eye, suggestive of cytomegalovirus uveitis and HIV infection and retinopathy, and confirmed by serology. The patient was treated with ganciclovir and highly active antiretroviral therapy and preserved contralateral vision. Clinicians should be aware of uveitis and retinopathies to prevent irreversible vision loss and systemic conditions.

RESUMO Paciente do sexo masculino, 41 anos, com queixa de perda de acuidade visual unilateral por 1 semana e sintomas constitucionais por 3 meses. Ao exame oftalmológico, apresentava exsudatos algodonosos, em olho direito, e áreas de necrose e hemorragias retinianas, em olho esquerdo, com suspeita de uveíte por citomegalovírus e retinopatia por HIV, confirmadas por sorologias. O paciente foi tratado com ganciclovir e terapia antirretroviral e preservou a visão contralateral. Os oftalmologistas devem estar atentos para casos de uveítes e retinopatias, para prevenirem perda visual irreversível e condições sistêmicas.

Morbimortalidad del traumatismo de recto extraperitoneal / Morbimortalidade do traumatismo do reto extraperitoneal / Morbidity and mortality of extraperitoneal rectal trauma

INTRODUCCION: Los traumatismos del recto extraperitoneal representan el 3 por ciento al 5 por ciento de todos los traumatismos y heridas abdominales y se destacan por la elevada morbimortalidad que presentan si no son diagnosticados y tratados precoz y adecuadamente. En la actualidad existe falta de consenso con respecto al óptimo manejo quirúrgico en el medio civil. OBJETIVO: Relatar la experiencia en el tratamiento evaluando aquellos factores que influyeron en la morbimortalidad. METODOS: Estudo retrospectivo descriptivo onde se revisaron los prontuarios de todos los pacientes operados por traumatismo recto extraperitoneal, entre enero de 1998 y diciembre de 2007. Las variables índice de trauma abdominal, intervalo entre trauma y cirugía y tipo de cirugía inicial fueron relacionadas con las complicaciones infecciosas y mortalidad. RESULTADOS: Se evaluaron 13 pacientes, 5 por herida de arma de fuego, 5 por autoempalamiento y 3 por trauma cerrado. El índice de trauma abdominal promedio en infectados y fallecidos fue superior a 25. El 61 por ciento de los pacientes(8) fueron operados antes de las 8 horas. La tasa de infección fue del 61,5 por ciento y el 90 por ciento de los pacientes infectados requirieron nuevas cirugías. La mortalidad de la serie fue de 38,5 por ciento (5 pacientes). En los pacientes intervenidos después de las 8 horas se registró un 80 por ciento de infección perirrectal y un 80 por ciento de mortalidad independientemente del tipo de cirugía realizada. CONCLUSIONES: El retraso en el tratamiento mayor 8hs y el índice de trauma abdominal mayor 25 fueron los principales factores asociados a infección perirrectal y mortalidad en esta serie. La ausencia de drenaje presacro y de lavado rectal distal se asoció a mayor incidencia de infección perirrectal.

BACKGROUND: Extraperitoneal rectal injuries represent 3 to 5 percent of all traumatisms and abdominal injuries, and they are highlighted by their high morbidity/mortality presented if not early and appropriately diagnosed and treated. Nowadays there is not a consensus related to an optimal surgical management. AIM: To relate the experience in treating this disease, evaluating factors that influence mortality and morbidity. METHODS: It consisted in a descriptive retrospective study where it was reviewed handbooks of all extraperitoneal rectal trauma patients operated between January 1998 and December 2007. The abdominal trauma rate, the interval between trauma and surgery and the initial surgery's type were related to infectious complications and mortality. RESULTS: There were evaluated 13 patients: 5 injured by firearms, 5 autoimpalament and 3 by closed trauma. The abdominal trauma mean rate of infected and dead was more than 25. 61 percent of patients (n=8) underwent surgery before 8 hours. The infection rate was 61.5 percent and 90 percent of infected patients required additional surgeries. The series' mortality was 38.5 percent (5 patients). In patients operated after 8 hours there was perirectal infection in 80 percent of them, and 80 percent of mortality regardless of surgery performed type. CONCLUSIONS: The delay over 8 hours in treating and the abdominal trauma rate over 25 were the main factors associated with perirectal infection and mortality in this series. Absence of presacral drainage and distal rectal wash were correlated with increased incidence of perirectal infection.