Physical Impact of SARS-CoV-2 Infection in a Population of Italian Healthcare Workers

SARS-CoV-2 infection often causes symptoms and illness that can last for months after the acute phase, i.e., so-called "Long COVID" or Post-acute COVID-19. Due to the high prevalence of SARS-CoV-2 infection among Healthcare Workers (HCWs), post-COVID-19 symptoms can be common and threaten workers' occupational health and healthcare systems' functioning. The aim of this cross-sectional, observational study was to present data related to post-COVID-19 outcomes in a population of HCWs infected by COVID-19 from October 2020 to April 2021, and to identify possible factors associated with the persistence of illness, such as gender, age, previous medical conditions, and features of acute illness. A total of 318 HCWs who had become infected by COVID-19 were examined and interviewed approximately two months after their recovery from the infection. The clinical examinations were performed by Occupational Physicians in accordance with a specific protocol at the Occupational Medicine Unit of a tertiary hospital in Italy. The mean age of the participants was 45 years old, and 66.7% of the workers were women while 33.3% were men; the sample mainly consisted of nurses (44.7%). During the medical examination, more than half of the workers mentioned that they had experienced multiple residual bouts of illness after the acute phase of infection. Men and women were similarly affected. The most reported symptom was fatigue (32.1%), followed by musculoskeletal pain (13.6%) and dyspnea (13.2%). In the multivariate analysis, dyspnea (p < 0.001) and fatigue (p < 0.001) during the acute stage of illness and the presence of any limitation in working activities, in the context of fitness for a work evaluation performed while the occupational medicine surveillance program was being conducted (p = 0.025), were independently associated with any post-COVID-19 symptoms, which were considered final outcomes. The main post-COVID-19 symptoms-dyspnea, fatigue, and musculoskeletal pain-showed significant associations with dyspnea, fatigue, and musculoskeletal pain experienced during the acute stage of infection, with the presence of limitations in working activities, and pre-existing pneumological diseases. A normal weight according to body mass index was a protective factor. The identification of vulnerable workers as those with limitations in working activities, pneumological diseases, a high BMI, and of an older age and the implementation of preventive measures are key factors for preserving Occupational Health. Fitness-to-work evaluations performed by Occupational Physicians can be considered a complex index of overall health and functionality that can identify workers who may suffer from relevant post-COVID-19 symptoms.

Correction: Mucci et al. WORKbiota: A Systematic Review about the Effects of Occupational Exposure on Microbiota and Workers' Health. Int. J. Environ. Res. Public Health 2022, 19, 1043

Eleonora Tommasi was not included as an author in the original publication [...].

Quality of life in liver transplant recipients during the Corona virus disease 19 pandemic: A multicentre study

BACKGROUND

Liver transplant recipients require specific clinical and psychosocial attention given their frailty. Main aim of the study was to assess the quality of life after liver transplant during the current pandemic.

METHODS

This multicentre study was conducted in clinically stable, liver transplanted patients. Enrollment opened in June and finished in September 2021. Patients completed a survey including lifestyle data, quality of life (Short Form health survey), sport, employment, diet. To examine the correlations, we calculated Pearson coefficients while to compare subgroups, independent samples t-tests and ANOVAs. To detect the predictors of impaired quality of life, we used multivariable logistic regression analysis.

RESULTS

We analysed data from 511 patients observing significant associations between quality of life's physical score and both age and adherence to Mediterranean diet (p < .01). A significant negative correlation was observed between mental score and the sedentary activity (p < .05). Female patients scored significantly lower than males in physical and mental score. At multivariate analysis, females were 1.65 times more likely to report impaired physical score than males. Occupation and physical activity presented significant positive relation with quality of life. Adherence to Mediterranean diet was another relevant predictor. Regarding mental score, female patients were 1.78 times more likely to show impaired mental score in comparison with males. Sedentary activity and adherence to Mediterranean diet were further noteworthy predictors.

CONCLUSIONS

Females and subjects with sedentary lifestyle or work inactive seem to show the worst quality of life and both physical activity and Mediterranean diet might be helpful to improve it.

Description of novel resistance islands harbouring blaCTX-M-2 in IncC type 2 plasmids

OBJECTIVES

We sequenced two IncA/C plasmids harbouring bla_CTX-M-2 in Klebsiella pneumoniae clinical isolates and compared their antibiotic resistance islands.

METHODS

Transconjugants were obtained from two clinical K. pneumoniae isolates harbouring bla_CTX-M-2. Plasmid DNA from transconjugants underwent short-read whole-genome sequencing, reads were assembled, and gaps were closed by PCR and sequencing. Determination of plasmid replicons, antibiotic resistance genes, identification and characterisation of insertion sequence (IS) elements, and comparison with publicly available plasmid sequences were performed.

RESULTS

bla_CTX-M-2 was located in a complex class 1 integron In35::ISCR1::bla_CTX-M-2, inserted in two different transposons designated Tn7057 and Tn7058, that reside in the resistance islands of plasmids pUR-KP0923 and pUR-KP1025, respectively. The general modules of both transposons were In35::ISCR1::bla_CTX-M-2-Tn1000-like-Tn2*-ISKpn11-12-13 variable module-ΔTn21. In Tn7057 there was ΔIS10R-catA2 associated with an additional ISKpn13. Both plasmids belonged to IncC type 2 and ST3. pUR-KP0923 was 167 138 bp in length and had a 37 926-bp resistance island at position 4 (RI-4). Plasmid pUR-KP1025 was 168 128 bp with a RI-4 of 36 222 bp.

CONCLUSION

This report describes the molecular nature of two transposons (Tn7057 and Tn7058) harbouring bla_CTX-M-2 that reside in IncC type 2 ST3 plasmids. These transposons mediate resistance to oxyimino-cephalosporins, gentamicin and, in the case of Tn7057, chloramphenicol. CTX-M-2 is an important extended-spectrum β-lactamase (ESBL) to South American epidemiology. It is remarkable that despite being only two plasmid sequences, the information revealed here could contribute to a better understanding of the resistance islands from IncC type 2 plasmids.

Respiratory function in wind instrument players

BACKGROUND

The playing of wind instruments has been associated with changes in respiratory function.

STUDY OBJECTIVES

To investigate the effect of playing wind instruments on lung function and respiratory symptoms.

METHODS

The present study included 99 wind instrument players and a group of 41 string instrument players as a control from 3 major orchestras in Zagreb, Croatia. Data on chronic respiratory symptoms were recorded in all studied subjects. Lung function was measured in wind instrument players by recording maximum expiratory flow-volume curves.

RESULTS

Wind instrument players demonstrated significantly higher prevalences of sinusitis, nasal catarrh and hoarseness compared to control musicians. One wind instrument player developed asthma associated with his work. Odds ratios for wind instrument players were significant for chronic cough, chronic phlegm and chronic bronchitis by smoking habit (p<0.05 or p<0.01) but not for length of employment. Ventilatory capacity data indicate that wind instrument players had significantly greater FEV1 (smokers and nonsmokers) as well as FEF50 (nonsmokers) (p<0.05) compared to predicted values. Regression analysis of pulmonary function tests in wind instrument players demonstrate a significant link between FEV1 and FEF50 and length of employment. Those wind instrument players with longer employment had the greatest increases in lung function.

CONCLUSIONS

Our data suggest that musicians playing wind instruments may be susceptible to chronic upper airway symptoms. Interestingly wind instrument playing may be associated with higher than expected lung function parameters.

Respiratory findings in art and medical students. Effects of the art environment

BACKGROUND

Art students are exposed to many noxious agents during their training, in contrast to medical students, who are not exposed to known environmental pollutants.

OBJECTIVES

In order to investigate the potential effects of toxic agents in the art students' environment, we studied respiratory findings in a cohort of 117 art students and 128 medical students, matched for age, sex and smoking.

METHODS

Acute and chronic respiratory symptoms were evaluated by modifying the British Medical Research Council questionnaire. Lung function studies were performed with a spirometer (Jaeger, Germany) measuring maximum expiratory flow-volume (MEFV) curves. On these curves we calculated the forced vital capacity (FVC), one second forced expiratory volume (FEV1) and the maximal expiratory flow at 50% and the last 25% of the FVC (FEF50, FEF25).

RESULTS

Significantly higher prevalences of most of the chronic respiratory symptoms were recorded in art students compared to medical students (p < 0.05). Art students who were smokers had significantly higher prevalences of many of the chronic respiratory symptoms than nonsmoking art students. Among medical students these differences were not statistically significant (NS). High prevalences of acute symptoms related to the study environment were recorded for art students. Odds ratios in male and female art students were significant for chronic cough, chronic phlegm and chronic bronchitis for the risk factor of smoking. Significantly decreased lung function values compared to predicted values were recorded mostly for FEF50 and FEF25 in male and female art students. Smoking and non-smoking art students had similar reductions of lung function. Lung function data in medical students were within predicted values.

CONCLUSIONS

Our data indicate that art students may be at risk of developing chronic respiratory symptoms and lung function changes as a result of their environmental exposure and their smoking habits.

Pharmacological Study of Oyster Mushroom (Pleurotus Ostreatus) Extract on Isolated Guinea Pig Trachea Smooth Muscle

Mushroom farm workers suffer from respiratory symptoms during the farming of mushrooms. The objective of this study was to analyze the effects of oyster mushroom (Pleurotus ostreatus) extract (OME) on isolated guinea pig tracheal smooth muscle in vitro. Isolated guinea pig tracheal tissue from 27 nonsensitized guinea pigs were studied. The OME was obtained from indoor mushroom growing fields and prepared as a 1:10 w/v aqueous solution. Dose-related contractions of nonsensitized guinea pig trachea were demonstrated using these extracts. The OME contained significant quantities of bacterial components (eg., endotoxin: 43,072.92 EU/mg). Parallel, pharmacological studies were performed by pre-treating the tissues with mediator-modifying agents including atropine, indomethacin, pyrilamine, BPB, acivicin, NDGA, captopril, TMB8 and capsaicin. Atropine consistently and strikingly reduced the contractile effects of this extract. These observations suggest an interaction of the OME with parasympathetic nerves or more directly with muscarinic receptors. Pretreatment with TMB8 (inhibitor of intracellular calcium mobilization) also significantly blocked the constrictor effect of OME, indicating a role of calcium mobilization in the constricting effect of OME. Inhibition of contraction by blocking of other mediators was less effective and varied depending on the drug. We conclude that OME causes a dose-related airway smooth muscle constriction by nonimmunological mechanisms involving a variety of airway mediators and possibly cholinergic receptors. This effect is not dependent on pre-sensitization of the guinea pigs.

The plastic surgeon and Graves disease

Thyroid-associated ophthalmopathy is a disease caused by autoimmune processes that also affects the thyroid gland and the lower limbs; at orbital level, it involves the muscle and adipose tissue. When medical treatment fails to achieve appreciable results, surgery aims to decompress the orbital cavity. In recent years, the treatment has been considerably improved by the introduction of transpalpebral lipectomy, which has produced valid results especially in cases when extrinsic muscle hypertrophy is limited; if it is severe, however, lipectomy can be combined with expansion of the orbital cavity, thus enabling the latter to be restricted to one or two walls instead of three. Studying 52 patients who underwent orbital decompression involving lipectomy and/or orbital expansion, affecting a total of 96 orbits, enabled an assessment of the pros and cons of the single techniques in an attempt to identify a rational approach to this pathology. It emerged that lipectomy alone may suffice and obtain valid results in cases of mild-to-moderate proptosis (up to 24 mm) with limited extrinsic muscle hypertrophy, whereas orbital expansion--with or without lipectomy--is likely to be necessary in moderate-to-severe cases (proptosis greater than 24 mm). Additional procedures to correct the elevator and retractor muscles of the eyelids were almost always necessary.

Contribution of clinical breast examination to mammography screening in the early detection of breast cancer

OBJECTIVES

As the benefit of clinical breast examination (CBE) over that of screening mammography alone in reducing breast cancer mortality is uncertain, it is informative to monitor its contribution to interim measures of effectiveness of a screening programme. Here, the contribution of CBE to screening mammography in the early detection of breast cancer was evaluated.

SETTING

Four Canadian organised breast cancer screening programmes.

METHODS

Women aged 50-69 receiving dual screening (CBE and mammography) (n = 300,303) between 1996 and 1998 were followed up between screen and diagnosis. Outcomes assessed by mode of detection (CBE alone, mammography alone, or both CBE and mammography) included referral rate, positive predictive value, pathological features of tumours (size, nodal status, morphology), and cancer detection rates overall and for small cancers (< or = 10 mm or node-negative). Heterogeneity in findings across programmes was also assessed.

RESULTS

On first versus subsequent screen, CBE alone resulted in 28.5-36.7% of referrals, and 4.6-5.9% of cancers compared with 52.6-60.1% of referrals and 60.0-64.3% of cancers for mammography alone. Among cancers detected by CBE, 83.6-88.6% were also detected by mammography, whereas for mammographically detected cancers only 31.7-37.2% were also detected by CBE. On average, CBE increased the rate of detection of small invasive cancers by 2-6% over rates if mammography was the sole detection method. Without CBE, programmes would be missing three cancers for every 10,000 screens and 3-10 small invasive cancers in every 100,000 screens.

CONCLUSIONS

Inclusion of CBE in an organised programme contributes minimally to early detection.

Reconstruction of the inner canthus region with a forehead muscle flap: a report on three cases

We report our experience of using a forehead flap to repair the defect left by the excision of skin tumours in the medial canthal region involving both eyelids in three patients. Both eyelids and the inner canthus were reconstructed using a myofascial flap taken from the forehead, combined with septal chondro-mucosal grafts, oral mucosa and skin grafts. After a careful anatomical study of the vascularisation of the frontal region, we used only the frontal myofascial portion, a part of the forehead muscle vascularised by the deep branch of the supraorbital artery and by the supratroclear artery; the skin left behind is adequately nourished by the fine mesh of anastomoses in the area between the two supratroclear arteries, the supraorbital artery and the terminal vessels of the superficial temporal artery. The particularly thin, elastic and resistant features of this flap enabled us to repair a loss of substance in a difficult area with a successful outcome in terms of morphology, function and cosmetic appearance.

Surgical repair of an anterior tibialis muscle hernia with Mersilene mesh

The most frequent muscle hernia of the lower extremities is the anterior tibialis muscle hernia. A number of surgical procedures are available for the treatment of symptomatic anterior tibialis muscle hernias. However, in case of a large fascial defect, their use may be unfeasible or inconvenient. Moreover, current surgical procedures are prone to the risk of an anterior tibial compartment syndrome. The use of a synthetic patch could provide an alternative, particularly for large defects. In this paper we report the repair of a large, symptomatic, long-standing anterior tibialis muscle hernia with polyester mesh (Mersilene) fixed to the edges of the defect (muscular fascia and tibial periosteum). This simple procedure provided excellent functional results and a good cosmetic appearance without complications and sequelae.

[Herpes simplex virus infection in pregnancy: epidemiologic, diagnostic and therapeutic data. An unusual case of HSV-1 in monozygotic twins]

The Authors report a case of two pre-term monocorial twins affected by HSV-1 infection (Herpes Simplex Virus type 1), with generalized sepsis and involvement of the central nervous system (CNS), born by mother with primary infection who presented a typical vesicular eruption a week before delivery. As the HSV-1 was a disseminated type and the CNS was involved in both the twins, the diagnosis was based on clinical and laboratory findings (specific IgM and IgG) and on the use of Delpech-Lichtblau antibody liquoral index, a significant results both in the first and the second twin. Intensive care and early specific treatment with Acyclovir allowed a slow but progressive improvement of the twins' clinical picture. The antibody liquoral index may therapy of the viral sepsis cases involving the CNS, more than the cultural or antigen isolation of the treated virus.

[Homologous intrauterine insemination: our experience]

Sixty-five couples with male infertility or unexplained infertility or infertility due to cervical factor underwent 156 cycles of homologue intrauterine insemination. The overall pregnancy rate was 16.5% with 2.4 mean value of insemination cycles for each couple. The highest pregnancy rate was observed in cases of cervical factor infertility. The mean age of patients who had pregnancy was 30 years (overall mean value 34 years) and the mean time of sterility was 3 years (overall mean value 4.4 years).

Use of the bilobed flap for coverage of exposed structures on the fingers

An original surgical procedure for the repair of soft tissue defects localized on the dorsal aspect of the proximal phalanx of the fingers is described. A patient was seen with a posttraumatic soft tissue loss corresponding to the dorsal aspect of the second metacarpophalangeal joint and the adjacent proximal half of the proximal phalanx of the index finger with extensor tendon exposure. The repair of the defect using a local flap taken from the second web space and the dorsum of the proximal phalanx of the long finger provided excellent coverage with early movement and a good functional result.

[Freeman-Sheldon syndrome. Case contribution and review of the literature]

The paper reports a case of Freeman-Sheldon's syndrome in which a medium-slight degree of mental retardation which was not associated to malformations of the CNS was observed in addition to other typical symptoms. The presence of an hiatal hernia and vesico-ureteral reflow was also noted; to date it is still not possible to establish whether these visceral anomalies are chance findings or whether they are the result of a genetic defect involving tissues of different embryonal origin. Further studies are required to increase our knowledge of Freeman-Sheldon's syndrome and other nosologically related pathologies.

[Hereditary angioedema, a rare cause of recurrent abdominal pains. A report of 2 clinical cases and comments of a general nature]

Two clinical cases of recurrent abdominal pain are reported. These led to the unusual diagnosis of hereditary angioedema due to deficiency of C1 esterase inhibitor (C1-INH). The difficulties of identifying this genetic disease were caused by the variability of its clinical expression: the alteration of an autosomal dominant gene triggers angioedema attacks that may strike the cutaneous, gastroenteric and respiratory apparatus with differing intensity. Various subjects suffering from hereditary angioedema were found in the genealogical trees of the two patients, but all had extraintestinal symptoms of very variable intensity. Measurement of C4 and C1-INH made it is possible to identify in the first family a functional defect of C1 esterase inhibitor and in the second a quantitative defect in the same inhibitor.

[Transient alkaline hyperphosphatasemia in childhood. A report of 4 clinical cases and etiopathogenetic hypotheses]

The paper reports four cases of idiopathic transient alkaline hyperphosphatasemia during episodes of acute infection of presumable viral etiology. It is interesting to note that one patient present a exanthematous febrile reaction to an anti-measles vaccination, which seems to confirm that the measles virus may be one of the possible causal factors of the pathology. The assay of alkaline phosphatase isoenzymes showed an increase in the three hepatic, bone and intestinal fractions, thus excluding a sectorial pathology (bone or hepatic). This will avoid the need to subject the child to superfluous diagnostic tests in this transient and benign condition of increased enzyme levels.

Metabolic and hormonal effects of early nutritional supplementation after surgery in burn patients

We evaluated, in burn patients, the metabolic and hormonal effects of early nutritional supplementation after a severe stress event represented by the deep surgical excision of the burn wounds and autograft coverage. The surgical procedure induced a 50% increase from baseline value of the resting metabolic rate. Immediate nutritional supplementation avoids the adaptive stress-related increments of urinary catecholamine excretion and glucagon secretion while insulin secretion is maintained. The urinary cortisol excretion, significantly increased after surgery in study and control groups, was unaffected by the nutritional intervention. The favorable insulin/glucagon ratio and the control of catecholamine response in early nutritionally supplemented patients are associated with the maintenance of a positive N balance in the days after surgery.

Very early nutrition supplementation in burned patients

We studied some metabolic and hormonal effects of a very early nutrition supplementation in burned patients. The patients were divided into two groups of 10 patients each. Supplementation in the first group, the very early nutritionally supplemented (VENS) group, was started immediately after admission, ie, after 4.4 +/- 0.5 h (mean +/- SEM) from the injury; it was started after 57.7 +/- 2.6 h from the injury in the second group (control group). Hormonal and metabolic indices were recorded every 4 d up to 28 d. In the VENS group, the nitrogen balance became positive in 8.8 +/- 4.1 d whereas it took 24.1 +/- 6.9 d in the control group (p less than 0.05). Urinary catecholamine excretion and plasma glucagon concentrations were lower during the first 2 wk of observation in the VENS group compared with the control group. Insulin concentrations were significantly higher on the fourth and eighth days in VENS patients and plasma cortisol concentrations were similar in both groups.

[Clinico-epidemiological research on the incidence of masticatory dysfunctions in periodontal patients]

The frequency of symptoms and signs of the craniomandibular-system dysfunctions were analysed in 70 patients selected because of their periodontal disease. The data obtained were compared with other data connected with epidemiological studies made on not-selected people.

Utilization of the superficial temporoparietal fascia in reconstructive plastic surgery. A clinical case

Reconstruction of the orbit can at times be difficult when tumors of this region are resected. We describe a new surgical procedure to reconstruct the outer canthus of the orbital region, including lateral portions of the upper and lower lids. The techniques that were used until now are often limited in repairing this anatomical area, and the results we obtained with this case encourage us to utilize the superficial temporal fascia.

[Congenital cardiopathy in a patient with Sotos syndrome. Description of a case]

The number of cases of Sotos syndrome or cerebral gigantism described in the literature total more than 200. For 6 of these, cardiac malformations were described. The authors report a case of Sotos syndrome in which malformative alterations of the aortic and mitral valves were simultaneously present.

Squamous cell carcinoma of the hand: fifty-five case reports

Although squamous cell carcinoma is the most frequent primary malignant tumor of the hand, in absolute terms it is rarely encountered. We describe a series of 55 cases of this tumor. Mortality caused by squamous cell carcinoma of the hand is higher compared with figures observed with the same lesion in other sites. The recurrence rate (22%) indicates a need for radical surgical resection and a three-dimensional histologic reconstruction of the lesion's extent. The incidence of metastasis is rather high (28%), and in all cases except one the regional lymph nodes were the first site of metastasis. Despite the presence of a metastatic lesion, lymphadenectomy apparently improves patient survival. Routine prophylactic lymphadenectomy has not yielded encouraging results. Lymphadenectomy is recommended in every patient with a recurrence, even though the nodes may not be palpable.

A study of renal damage in seriously burned patients

The incidence of acute renal failure (ARF) in severely burned patients ranges from 1.3 per cent to 38 per cent and this complication has always been associated with a high mortality rate, of between 73 and 100 per cent. At present the exact mechanisms responsible for the onset of this complication are not well known. In order to elucidate some of these mechanisms, 20 patients with severe burns were studied for 1 year in an attempt to assess the prevailing glomerular or tubular localization of renal damage; the organic or functional pattern of renal damage and the reliability and possible prognostic significance of some renal function indices. These included the fractional excretion of sodium (FeNa), the alpha-glucosidases, the leucine aminopeptidases (LAP) and the serum and urine beta 2-microglobulin. The incidence of ARF in the patients studied was 26 per cent and in all cases it was of polyuric type. We believe that renal damage very often remains undetected when the traditional testing methods are used and that only in some patients does it become severe enough to result in ARF. In contrast, some of the tests considered in our study are extremely useful and reveal an impairment of renal function long before it becomes clinically apparent.

Alanine and aspartate aminotransferase serum levels in burned patients: a long-term study

Increased alanine and aspartate aminotransferase (ALT and AST) serum levels are usually considered expressions of cellular necrosis, especially in hepatocytes. They represent cellular damage due to burn which, according to many authors, becomes normal before discharge of patients. We studied 43 consecutive burned patients, both during and after recovery, from a minimum of 120 to a maximum of 640 days, and an average of 18.62 blood samples were taken from each patient. Hepatitis A and B markers were tested. Results showed a 67.44% increase in aminotransferases in patients during recovery and a 25.58% increase after discharge. No neopositivity was observed for hepatitis A and B markers. We therefore conclude that the increase of enzymes during recovery expresses a toxic-infective phase and this increase, contrary to what was believed, does not always drop to normal values at time of discharge. Instead, after discharge, higher values can be a manifestation of a Non-A Non-B hepatitis.

Aminotransferase changes in burned patients

The time course of serum transaminases (alanine aminotransferase and aspartate aminotransferase) has been followed in 30 selected consecutive patients presenting burn sizes ranging from 10% to 95% of the total body surface (mean 43.13) and a survival index from 0.99 to 0.00 (mean 0.59). The results show that in all the patients both transaminases change in parallel, increasing in 18 patients (60%). In nearly all patients both enzymes increase during the second week after injury and aspartate aminotransferase increases later than alanine aminotransferase. The higher transaminase levels are noted in moderately ill patients. No clear correlation between the overall increase of transaminases and the extent of burned surface area has been found. We conclude that functional liver alterations mostly contribute to the increase of serum transaminases in burns.