The safety of pneumococcal vaccines at the time of sequential schedule: data from surveillance of adverse events following 13-valent conjugated pneumococcal and 23-valent polysaccharidic pneumococcal vaccines in newborns and the elderly, in Puglia (Italy), 2013-2020.

Background: Nowadays, two types of anti-pneumococcal vaccine are available: pneumococcal 13-valent conjugate vaccine (PCV13), first licensed in the United States (US) in 2013, and pneumococcal 23-valent polysaccaridic vaccine (PPSV23), first licensed in the US in 1999. These vaccines are recommended in Italy for the immunization of newborns and of the elderly, using a combined sequential schedule for the latter. This report aims to describe the PCV13- and PPSV23-related AEFIs notified in Puglia in 2013-2020, in order to design these products' safety profile in a real-life scenario, three years after the official recommendation about the sequential schedule for people over 60 years of age. Methods: This is a retrospective observational study. Data were gathered from the list of AEFIs notified following PCV13 and PPSV23 administration in Puglia in 2013-2020. The number of administered vaccine doses was obtained from the regional immunization database. AEFIs were classified according to WHO's algorithm, and causality assessment was carried out in case of serious AEFIs. Results: From January 2013 to December 2020, 764,183 doses of PCV13 and 40,382 doses of PPSV23 were administered in Puglia. In the same period, 71 PCV13 AEFIs (Reporting Rate: 9.29 x100,000 doses) and 5 PPSV23 AEFIs (Reporting Rate: 12.4 x100,000 doses) were reported. The overall male/female ratio in AEFIs was 0.85. The majority of AEFIs occurred in subjects aged less than 2 (64/76, 84.2%), while 10 out of 76 (13.2%) occurred in patients aged 60 or older. 22 AEFIs were classified as serious and for 12 (54.5%) causality assessment showed a consistent relationship with immunization. The most commonly reported symptoms were fever (Reporting Rate: 4.72 x100,000 doses) and neurological symptoms (Reporting Rate: 3.23 x100,000 doses). Only one death was notified, classified as non-vaccine-related. Conclusions: The benefit of pneumococcal vaccination appears to be greater than the risk of AEFIs for both PCV13 and PPSV23. In fact, AEFIs occur in less than 0.1‰ of patients and the majority of AEFIs are mild and self-limiting.

A COVID-19 nosocomial cluster in a university hospital in southern Italy: a social network analysis.

Introduction: Healthcare workers on duty at the hospital are at high risk of COVID-19 infection. However, despite the introduction of risk-lowering practices in the hospital setting, there have been many cases of SARS-COV-2 infection among Health Care Workers. Fast and efficient contact tracing and Sars-CoV-2 PCR-based testing of the close contacts of Health Care Workers with confirmed infections are essential steps to limit nosocomial outbreaks. Methods: This cross-sectional study was conducted at Bari Policlinico General University-Hospital (Apulia, Italy) and describes the management of a cluster of SARS-COV-2 infections in three Operative Units. The contact tracing activities and the measures implemented to control the outbreak are described. Results: Among the 186 Health Care Workers active in the cluster setting, there were 9 (4.8%) confirmed cases, including the index case. Due to the outbreak, three Operative Units were closed to limit virus circulation. Health Care Workers with confirmed infections tested negative after a mean of 28.0±6.6 days (range: 13-37) and none required hospitalization. Conclusions: Protection of the health of Health Care Workers during the COVID-19 pandemic should be a public health priority. However, despite recent recommendations and the implementation of protective measures, SARS-COV-2 infections of Health Care Workers remain at a high rate, indicative of the continued high risk of cluster onset in the nosocomial setting.

Incidence of SARS-COV-2 infection among swimming athletes: data from real life in Apulia (Italy), July 2020/August 2021.

Background: As other indoor sports facilities, swimming pools were closed in Italy from March to May 2020 and from October 2020 to July 2021 due to the outbreak of the COVID-19 pandemic; access to these facilities was restricted to athletes of national relevance. This decision was based on "precautionary principles" and without evidence of a high risk of SARS-COV-2 circulation among swimming pools' attendants. The aim of this paper is to describe the pattern of SARS-COV-2 circulation among swimming athletes in Apulia (Southern Italy). Study design: The study aims to investigate the hypothesis that attending a pool increases the risk of SARS-COV-2 infection. The outcome measure is the incidence of SARS-COV-2 infection among swimming athletes compared with the general population. Methods: This is a retrospective cross-sectional study carried out in Apulia, Southern Italy. The study was performed through the analysis of both the database of the Italian Swimming Federation and the SARS-COV-2 infections in Apulia Region, from July 2020 to August 2021. Results: Among 2,939 federally licensed athletes, 221 had an history of SARS-COV-2 infection from July 2020 to August 2021, with an incidence of 75.2 /1,000. In the general Apulian population, during the same time span, the incidence of SARS-COV-2 infection was 67.3/1,000 and - considering the incidence rate ratio - there is no difference between the two populations (IRR=1.1; 95% CI=0.9-1.3; p>0.05). Conclusions: The incidence of SARS-COV-2 infection in Apulian swimmers showed no significant differences with the general population.

A new paradigm of hospital care for SARS-COV-2 patients in the post-emergency phase in Italy.

Abstract: In Italy, at the beginning of the SARS-CoV-2 pandemic, the main organizational model of hospital care was represented by the physical or functional division of hospitals and wards into COVID and non-COVID areas, in order to separate SARS-CoV-2-infected patients from the others. Now that the emergency phase has reached its long-awaited end, it is necessary to develop a new hospital care paradigm that may deal with SARS-CoV-2-positive patients discriminating between those who are hospitalized because of COVID-19 and those who are diagnosed with SARS-CoV-2 infection immediately before or after the first access to healthcare facilities.

A public health perspective on the responsibility of mass media for the outcome of the anti-COVID-19 vaccination campaign: the AstraZeneca case.

Abstract: On February 9, 2021, the Italian Ministry of Health made the "Covid-19 vaccine AstraZeneca" (now "Vaxzevria") available for use in the anti-COVID-19 vaccination campaign. However, in early March, the media reported that five people died a few days after receiving the vaccine. The reaction among both those already vaccinated and the vaccine candidates was one of near panic. The subsequent events have had long-lasting consequences, as 10-20% of vaccine candidates have since refused vaccination with the AstraZeneca vac-cine, so in addition to the delay in vaccination, ~200,000 doses of it were not administered. The goal of the vaccination campaign in Italy, when operating at full capacity, was to administer 500,000 doses per day, for a total of 3,500,000 doses per week. In this large amount of people, it is statistically certain that a certain number of subjects will develop non-vaccine related health problems or even die from causes unrelated to having been vaccinated. At this time in history, press reports must be inspired by a strong sense of responsibility and awareness of the potential consequences of misinformation; this is particularly true, especially because also the social media get inevitably involved.

The university as a safe environment during the SARS-COV-2 pandemic: the experience of Bari Politecnico.

the SARS-CoV-2 pandemic started in December 2019 and still remains a major global health issue. Every country in the world has adopted drastic measures to contain the virus, although their stringency varies among countries, ranging from increased surveillance and focused interventions to strict lockdown (1). Italy was the second country where the disease had a major impact early in the pandemic, such that a strict nationwide lockdown was declared from March 9 to May 3, 2020. Nonetheless, between January and May 2020, there were 210,000 COVID-19 cases in Italy and 29,000 deaths were recorded (2). Due to the lockdown, universities (and in general all educational services) shifted to online classes, with students attending lessons and taking their exams from home. On-site activities were reduced to those considered indispensable. Research activities also had to be modified, such as by the adoption of a smart-working model (3). Between May and August 2020, the number of SARS-CoV-2 infections in Italy decreased. In response, the lockdown was loosened and some activities were restarted, albeit with specific safety protocols (social distancing, use of masks, temperature checks at the workplace entry, environmental disinfection, mixed models of smart and in-office work). These actions were accompanied by periodic serological and PCR screening tests (4).

Prevalence of cigarette smoking: a cross-sectional survey between individual and team sport athletes.

BACKGROUND: Studies on the relationship between sport and smoking among adolescents and young adults reported contradictory results: some findings indicate that sport is a protective factor against smoking initiation, while other studies documented the inclination to unhealthy habits among athletes. The aim of this study was to evaluate smoking prevalence in a sample of young athletes practicing team (football, basket) or individual (swim) sports. STUDY DESIGN: Cross-sectional study carried out in a convenience sample of athletes. METHODS: The survey was performed by a self-administered, anonymous questionnaire. RESULTS: The study included 327 athletes, 81.0% male, with an average age of 16 years; 36.7% play football, 31.8% basketball, and 31.5% swim. Smoking prevalence among participants was 16.8%. Basket and soccer players were 3 times more likely to be current smokers (20.1%), particularly those aged 16-18 years (35.9%), compared to swimmers (7.8%; in 16-18 year-old: 11.3%). Moreover, basket and soccer players were 7 times more likely to be smokers and to smoke before the practice session compared to swimmers. CONCLUSION: Smoking prevalence in all athletes was lower than that observed in youths. However, athletes of team sports were three times more likely to smoke than athletes of sprint and resistance sports. The reason is likely to be psychological: these sports, not focusing on the individual physical performance, allow athletes to feel less responsible for successes of their teams. It is essential to ensure a specific alliance for prevention between Health and Sport authorities, such as Federations and sporting societies, in order to develop interventions to inform athletes of team sports about the health and physical risks associated to smoking.

Extracorporeal shockwave therapy on muscle tissue: the effects on healthy athletes.

The aim of this study is to investigate the effects of extracorporeal shock wave therapy (ESWT) on muscle rheological and functional properties in a population of young athletes. Thirty-two football and basketball players were recruited and randomized into two groups. The athletes underwent three sessions of therapy administered every five days to the thigh muscles. The treatment consisted of ESWT (electromagnetic generator, Energy Flux Density=0.03 mJ/mm2) or a placebo treatment bilaterally on the quadricep and femoral bicep muscles. Monitoring was carried out at recruitment (T0), at the end of treatment (15 days, T1) and at 30 days (T2) with myometric evaluation (measuring elasticity, stiffness and muscular tone) and electromiography exam (recording the Motor Unit Amplitude Potential values). The results showed a significant increase in the treated athletes in the elasticity (lateral vastus muscle, p=0.007), in muscular tone (femoral rectus, p=0.031) and in muscular recruitment (the lateral vastus, p<0.005; medial vastus muscle, p=0.055). These results could represent a translational interpretation of the known biological effect on connective tissue: an increase in blood flow, oxygenation, metabolic process activation and proliferative effect. The effects found may represent the justification for verifying the usefulness of using of shockwave therapy to reduce muscular fatigue and improve performance during the sport season.

Reactive oxygen metabolites in alpha-herpesvirus-seropositive Mediterranean buffaloes (Bubalus bubalis): a preliminary study.

In the present study on Bubalus bubalis of the Campania Region (Italy) the serum levels of derivatives of reactive oxygen metabolites (d-ROMs), anti-ROM and oxidative stress index (Osi) were evaluated. These data were then related to the seropositive status of the animals against alpha-herpesviruses, precisely Bubaline herpesvirus 1 (BuHV-1) and Bovine herpesvirus 1 (BoHV-1). Clinically healthy Mediterranean buffaloes were selected for this study. The serum samples of these animals were taken, and d-ROMs, anti-ROM and Osi were measured using commercially available tests. The preliminary data demonstrated that animals seropositive to both BuHV-1 and BoHV-1 present more oxidative stress than seronegative animals, as revealed by a significant increase in d-ROMs. Our results provide, for the first time, insight into the reac- tive oxygen species (ROS) modulation induced by the herpesvirus in Bubalus bubalis.

Epidemiology and cost of cervical cancer care and prevention in Apulia (Italy), 2007/2016.

BACKGROUND: According to recent estimates, cervical cancer is worldwide the second most common cancer in females and the fourth overall. The number of deaths for cervical cancer is around 7.5% of all female cancer deaths. Cervical cancer is the only tumour with a known necessary cause, the HPV infection and, globally, HPV is the most common sexually transmitted infection. Two major approaches for cervical cancer prevention have been designed: primary prevention by HPV vaccination and secondary prevention by screening. The aim of our study is to design an overview of epidemiology, cost of the therapies and cost of prevention measures (screening and vaccines) 9 years after the introduction of anti-HPV vaccination in the Apulia Regional Immunization Program. STUDY DESIGN: Retrospective observational study. METHODS: To describe the epidemiology of cervical cancer, we analysed data from the Apulia regional archive of hospital discharge forms (SDO). We considered all records referred to cervical cancer using the ICD 9 code 180.xxx both in primary and secondary diagnosis, for the years 2007-2016. Subjects living in Apulia have been considered. Costs of hospitalization were computed considering generated Diagnosis Related Groups (DRG). To describe the Apulian screening program, we analysed data from Regional Screening Data warehouse; the cost of the single test was established according to the Tariff List from the Ministry of Health. Finally, vaccination data were extracted by Regional Immunization Database and official ex-factory price has been used to calculate the costs of immunization program. RESULTS: From 2007 to 2016, an important decrease in the incidence rate of cervical cancer in Apulia has been noted, ranging from 43.7 per 100,000 residents in 2007 to 21.0 per 100,000 residents in 2016. From an economic point of view, a clear reduction (39%) is observed in hospitalization costs over time. Total costs of prevention programs increased over time and globally exceed € 54,000,000, with a decreasing trend for vaccine prophylaxis and an increasing trend for screening. CONCLUSIONS: The incidence and costs of cervical cancer in Apulia, although already significantly decreasing, likely will be further reduced since 2027-2032, when we can observe the effects of vaccine prophylaxis on the burden of disease; on this occasion it will be also possible to quantify the actual cost-effectiveness of the vaccine. In our opinion, in the future the Apulia healthcare executives should enhance and improve the active screening test offer, without underestimating the importance of sexual education in young people, especially in those who have not had sexual debut yet.

Cardiopathy and osteoporosis: the epidemiology in a region of Italy.

Cardiopathies and osteoporosis are inter-related due to pathogenetic, hormonal, genetic features as well as an increased risk of fragility. An important feature is attributed to the process of atherosclerosis, which is responsible for an osteopenia effect and degeneration of vascular walls. To date the study populations have been limited. To verify the incidence of cardio-vascular disease in a larger osteoporotic population, we designed a retrospective clinical study analyzing the “Hospital Discharge Data” (HDD) in Apulia between 2006 and 2010. All patients over 55 years with a hospitalization for a fragility fracture and/or drugs prescription for osteoporosis were crossed with the diagnosis and/or drugs prescription for cardiovascular disease. We observed that between 2006 and 2010, in Apulia, 177,639 patients were hospitalized and diagnosed as having fragility fractures, 66.3% had a diagnosis of cardiopathy, with a higher prevalence in males and in patients over 80 years. The incidence of fractures were as follows: femur (51.9%), spine (20.2%), humerus (10.6%), forearm (9%), tibial pilon (7.2%) and tarsus and metatarsus (1.1%). Cerebrovascular diseases were the most frequent, followed by arrhythmias, heart failure and cardiomyopathies. In these patients, the most prescribed drugs were anti-coagulants, ACE inhibitors and diuretics. In patients affected by cerebral circulation disorder there is a greater propensity to fall and thus have a fragility fracture, particularly of the femur. The vertebral fracture, misdiagnosed in 60-70% of patients, may compromise the cardio-respiratory function of these patients. We verified a higher incidence of fragility fractures in patients who were prescribed certain categories of drugs for the treatment of cardio-vascular disease. This hypothesis is not supported by the literature, where contradictory results on the potential effects of these drugs on bone have been published. The high incidence of heart disease found in patients with fragility fractures supports the need for specific screening for osteoporosis in the population with cardio-circulatory pathology.

Short term efficacy of capacitive-resistive diathermy therapy in patients with low back pain: a prospective randomized controlled trial.

To compare the effectiveness of Doctor Tecar TherapyTM with that of laser therapy in the management of low back pain (LBP), a total of 60 patients with LBP were enrolled. The participants were randomly divided into two groups: a Tecar group (experimental group, 30 subjects), and a laser group (control group, 30 subjects). All the subjects received 10 sessions of therapy: one each day from Monday to Friday and the same again the following week. All the subjects were evaluated for pain (VAS) and disability (Roland and Morris score and Oswestry score) at baseline (T0), and 2 weeks (T1), 1 month (T2) and 2 months (T3) after the end of treatment. The pain and disability presented a trend to improvement over time in both groups. This improvement was statistically significant at all follow-ups (FUs) in the Tecar group but only at T1 for the Laser group (p less than 0.01). Comparing the two methods, there emerged a significant difference in favour of the Tecar group at T2 and T3 (p less than 0.01). The results show that Tecar therapy determined significant improvement already by the end of the treatment. Moreover, at the first and second month FUs, the Tecar therapy showed statistically better results than laser therapy.

ACTN3/ACE genotypes and mitochondrial genome in professional soccer players’ performance.

Two nuclear genes, ACTN3, encoding for the α-actinin skeletal muscle isoform 3, and ACE encoding the angiotensin-converting enzyme, have both been associated with quantitative physical performance traits in the general population. The purpose of our study was to assess the association between the two nuclear gene variants, R577X (rs1815739) in ACTN3 and I/D (rs4340) in ACE, with elite athletes’ performance and the effect of training on the mitochondrial DNA (mtDNA) content in peripheral blood. We evaluated the genotypes and frequencies of ACTN3 R577X and ACE I/D polymorphisms between soccer players (n = 43) and healthy non-athletic controls (n = 128). Total DNA was extracted from peripheral blood samples using the standard procedure. The genotypes were assessed by PCR-RFLP analysis and mtDNA cellular content by RT-PCR. The soccer players showed a tendency to a prevalence of ACTN3RR and ACEDD genotypes both independently and in co-occurrence. The effect of physical training on the mitochondrial DNA content in the athletic population was reflected strikingly in its increase in peripheral blood. Based on our results, we suggest that the analysis of ACTN3 and ACE genotypes could predict talent in the soccer field and that knowledge of the genetic variants could determine types and training times for soccer players. In addition, the novelty of this work, never before described in the sports literature, is that the increase of mitochondrial content can be correlated with the training load, suggesting that the mtDNA copy number may be considered a viable bioenergetics biomarker.

Tendonitis of the rotator cuff treated with extracorporeal shock wave therapy: radiographic monitoring to identify prognostic factors for disintegration.

Extracorporeal shock wave therapy (ESWT) is widely used for calcific tendonitis of the shoulder. The initial rationale for this therapy was to break the calcification, but this effect does not always occur. To date, we do not know how calcifications evolve or why they may be less responsive to the action of the shock waves. One hundred and seventy-four shoulders with calcific tendinitis were prospectively evaluated before and after ESWT, using the radiographic classifications according to Gartner and Heyer, to Bosworth and to Molè. Three months after ESWT therapy, we observed the disappearance of calcification in 36.8% of the shoulders, a reduction in size in 21.8% and no change in 41.4%. The calcifications that disappeared were large according to Bosworth (p=0.004). The probability of disappearance of calcification increased with increasing age (p=0.011), for medium calcifications according to Bosworth (p=0.001), and calcifications of type A according to Molè (p=0.043). The results of our study suggest that the radiographic aspects of calcific tendonitis of the rotator cuff could influence the disruptive effects after ESWT. With this knowledge we could define the timing of treatment and therapeutic choice for each patient.

High level laser therapy for the treatment of lower back pain: clinical efficacy and comparison of different wavelengths.

High energy laser therapy (HELT) could be a new alternative treatment for lower back pain (LBP), which is a significant public health problem. Nevertheless, differences between the various light waves of HELT have not yet been fully researched. Sixty-six patients with lower back pain were treated using a high energy laser therapy. They were randomized into three different protocols which differed according to wave length (650 nm, 810 nm and TRIAX, which is simultaneous emission of 810 nm, 980 nm e 1064 nm). The other parameters remained constant (5 W and 50 J/cm2 for ten daily sessions). The visual analogue scale (VAS), the Roland Scale, and the Oswestry Score were measured before treatment (T0), and at end of the treatment session (T1) and 1 month (T1), 2 months (T2) and 4 months of follow-up (T4). In each group we verified a statistically significant improvement over time and that there was a relationship between the time and treatment (p less than 0.01). At T1 for all wavelengths we found a statistically significant improvement of three scores (p less than 0.01), which was maintained up to T4. The group treated with 810 nm HELT, showed a better remission of pain on the VAS scale, and disability on the Oswestry Scale at T4 (p=0.01). Comparing T0-T1 the variation in the Roland Score was significant in the patients treated with 810 nm (p less than 0.01). All the wavelengths analyzed proved to be efficacious for LBP. The greater efficacy of 810 nm in promoting nerve regeneration and in modulating the nociception transmission could explain the better outcomes.

Epidemiology of diabetes mellitus in the fragility fracture population of a region of Southern Italy.

Increased risk of osteoporosis and its clinical significance in patients with diabetes is controversial. This study aims to increase the data which are available regarding the prevalence of diabetes mellitus in patients affected by fragility fracture in Italy. We retrospectively studied Hospital Discharge Data (HDD) in the Apulian database for the period 2006–2010 to identify a fragility fracture diagnosis in males over 65 years of age and in females over 50. The database was then checked for drug prescriptions to identify those persons who had taken at least one osteoporosis drug. Within this latter group, thanks to hospital admission and prescription records, the subjects affected with diabetes mellitus were identified. Between 2006 and 2010 in Apulia 177,639 patients were hospitalized and diagnosed as having fragility fracture. The greatest number of those fragility fractures were found to be in the 70 to 79 age range (64,917 total; females 56,994, males 7,923). The prevalence of diabetes subjects in Apulia in this period was estimated at 6.5%. In the same region and period 21.1% of subjects affected by diabetes experienced a fragility fracture; in particular, this number was 27% for males and for 20.5% females. This is the first study providing data on the prevalence of fragility fractures and diabetes in the Apulian population. The data confirm that diabetes is a risk factor which influences bone density and risk of fractures and therefore the need of osteoporosis screening and treatment in diabetic patients.

Non-surgical periodontal management in scleroderma disease patients.

The aim of the present study is to investigate the periodontal status of people with scleroderma and their response to non-surgical treatment protocol aimed at controlling the evolution of the disease. The response to non-surgical periodontal treatment was tested on patients belonging to a scleroderma group and a control group: the data show an improvement of the periodontal conditions of all these patients in response to treatment. When compared on the same diagram, a slight remission of the periodontal disease was obtained in both scleroderma and healthy patients. This highlights the benefit to soft tissues produced by non-surgical periodontal treatment also in patients affected by systemic diseases.

Conventional fascial technique versus mesh repair for advanced pelvic organ prolapse: Analysis of recurrences in treated and untreated compartments.

117 women with severe pelvic organ prolapse (POP; stage > 2) were enrolled to elucidate a 24-month outcome of POP surgery, using conventional or mesh repair with 3 techniques. 59 patients underwent conventional repair and 58 underwent mesh repair. Two types of mesh were used: a trocar-guided transobturator polypropylene (Avaulta, Bard Inc.) and a porcine dermis mesh (Pelvisoft, Bard Inc.). Women with recurrences, who underwent previous unsuccessful conventional repair, were randomised. Primary outcome was the evaluation of anatomic failures (prolapse stage > 1) in treated and untreated compartments. Anatomic failure was observed in 11 of 58 patients (19%; CI 8.9-29) in the mesh group and in 16 of 59 patients (27.1%; p value = 0.3) in the conventional group. 9 of 11 failures in the mesh group (15.5%; CI 6.2-24.8) were observed in the untreated compartment (de novo recurrences), 14.3% in Pelvisoft and 16.7% in Avaulta arm, while only 1 recurrence in the untreated compartment (1.7%) was observed in the conventional group (odds ratio 10.6, p = 0.03).

Risk of infectious mononucleosis among agonistic swimmers: a cross-sectional study.

BACKGROUND: The risk of infectious mononucleosis among athletes is quite debated. Some personal observations seem to suggest an increase risk of mononucleosis among athletes, because they attend always close settings with an high probability of respiratory pathogens transmission; overtraining has been also proposed as risk factor. STUDY DESIGN: Cross-sectional study in a group of swimmers (aged 11-14 years) of the University Sport Centre of Bari. METHODS: 40 swimmers were interviewed by healthcare personnel at the end of training courses; demographic characteristics, personal habits, information about sport training and diagnosis of mononucleosis were analysed. RESULTS: The life-time incidence of mononucleosis was around 40%; multivariate analysis showed the association between mononucleosis and use of bottles of other persons (aOR=8.2; 95% CI=1.4-49.2; z=2.32; p=0.021) and average duration of training session was longer among subjects who reported mononucleosis than in subjects who did not indicate this disease. CONCLUSIONS: Future multi-centric studies are needed to better define the epidemiology of the mononucleosis in sport settings and to formulate appropriate recommendations to prevent the spreading of this disease.