[Molecular mimicry between Plasmodium sp and Guillain-Barre syndrome antigens]

OBJECTIVE

Analyze the molecular mimicry between Plasmodium spp. and autoantigens associated with GBS, identifying possible antigenic epitopes.

METHODS

PSI-Blast, Praline, Emboss, Protein Data Bank, Swiss Model Server, AlphaFold 2, Ellipro and PyMol 2.3 were used to search for homologies, perform alignments, obtain protein structures, and predict epitopes.

RESULTS

17 autoantigens and seven immunological targets of the peripheral nervous system were included, identifying 72 possible epitopes associated with GBS. From the proteome of Plasmodium spp. (298 proteins), only two showed similarities close to 30% with TRIM21 and BACE1, generating seven possible epitopes.

CONCLUSION

No significant homologies were observed between the proteome of GBS and Plasmodium spp. The exploration of other mechanisms such as immune-mediated capillary damage, Epitope Spreading or Bystander Activation is suggested to explain the mentioned association. These findings underscore the need to clarify the etiology of autoimmune diseases and the role of pathogens. The need for experimental studies to validate these results is emphasized.

Case report: Area of focus in a case of malignant hypertension

Malignant hypertension (MH) is characterized by severe hypertension (usually grade 3) associated with fundoscopic changes (flame hemorrhages and/or papilledema), microangiopathy and disseminated intravascular coagulation. In addition encephalopathy, acute heart failure and acute deterioration in renal function may be present. The term "malignant" reflects the very poor prognosis for this condition if untreated. When severe hypertension is associated with hypertension-mediated organ damage (HMOD) a life-threatening situation that requires immediate but careful intervention occurs (hypertensive emergency). In the last few years an increase in the number of patients with malignant hypertension has been observed, especially among those patients with black ethnicity. Limited access to treatment and the poor adherence to anti-hypertensive therapy may contribute to the development of hypertensive emergencies. It is considered appropriate to study patients in order to rule out thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. In fact, the microvascular damage caused by malignant hypertension can favor intravascular hemolysis like Thrombotic Microangiopathies (TMs). TMs may present in three different clinical conditions: typical hemolytic uremic syndrome (HUS), atypical hemolytic uremic syndrome (aHUS) and thrombotic thrombocytopenic purpura (TTP). TMs can arise in the context of other pathological processes, including malignant hypertension.

A case of Vaccine-Induced Thrombotic Thrombocytopenia (VITT) with thrombosis of the superior mesenteric artery after ChAdOx1 nCov-19 COVID-19 Vaccine

We describe the case of a 64 years-old woman admitted to the Emergency Department of the ASST-Spedali Civili of Brescia with fever and gastrointestinal symptoms 10 days after the first dose of ChAdOx1 nCov-19 vaccine. Laboratory investigations showed severe thrombocytopenia and high D-dimer, while an abdominal CT scan reported a partially occluding thrombosis of the superior mesenteric artery. Following treatment with fondaparinux, immunoglobulins and high dosage steroid therapy, we observed a rapid improvement of patient’s conditions. An ELISA assay showed the presence of antibodies against heparin PF4-complex. Subsequent abdominal CT-scan showed the superior mesenteric artery thrombosis resolution, and the patient was finally discharged after 12 days of hospitalization. Several reports pointed to the venous system as the main district affected by Vaccine-Induced Thrombotic Thrombocytopenia (VITT), while a peculiar feature of this report is the involvement of the mesenteric arterial system. Further investigation of VITT’s pathophysiological mechanisms is mandatory to develop preventive strategies and effective treatments.

Sick Building Syndrome like Symptoms in Emergency Prefabricated Accommodation

The present study investigated the sources of discomfort and the symptoms reported by earthquake victims residing in temporary emergency prefabricated accommodation (prefab). The investigation was carried out by means of a questionnaire. 203 prefab occupants and 132 inhabitants of houses, who were chosen as reference population, replied in winter and 233 prefab occupants and 154 inhabitants of houses replied in summer. In both seasons more people living in prefabs identified dry air, stuffy air, stale air, dust, dampness, uncomfortable temperature and bad odours as sources of discomfort. They also complained of general symptoms (headache, irritability, insomnia, difficulty in concentration) and irritative symptoms of the eyes, upper and lower airways and skin. Multiple regression analysis identified the type of accommodation as the variable that most influenced the onset of general, ocular, upper and lower airway symptoms. Intrinsic characteristics of the prefabs (being constructed with synthetic materials, combustion sources, poor ventilation and insulation) and psychosocial factors e. losing their home, could have contributed to the onset of symptoms.

Serum Clara cell protein (CC16) in healthy young smokers

The CC16 microprotein is the main secretory product of Clara cells, which are epithelial cells lining lung airways. In crossing through the bronchoalveolar/blood barrier, CC16 diffuses passively into plasma. Serum CC16 (sCC16) has recently been proposed as a biomarker for detecting Clara cell impairments. The aim of this study was to assess if sCC16 concentrations are reduced in a group of healthy young smokers. A group of 118 healthy young males volunteered to take part in the study. Each subject answered a questionnaire, and provided blood and urine samples. Serum CC16, urinary cotinine and creatinine were measured. Median serum CC16 concentrations were lower in smokers than in non-smokers (11.3 mug l(-1) vs 14.6 mug l(-1); p = 0.005; N = 89 and 29, respectively) but did not correlate with either the daily or the life-time cigarette consumption, or with urinary cotinine concentrations. sCC16 did not correlate with age or body mass index in the whole study population or in the groups of smokers and non-smokers. These results suggest the reduction in sCC16 concentrations in a group of healthy young smokers may be an early effect of cigarette smoking.

Toxicity of cadmium on Sertoli cell functional competence: an in vitro study

Cadmium (Cd), an ubiquitous environmental metal, mainly used for industrial purposes, may be toxic at level of the reproductive system. Testis tubular-based Sertoli cells (SC), play a major role in constituting the blood-testis barrier and provide a unique microenvironment for the genesis and differentiation of germ cells. Hence SC strictly control sperm qualitative and quantitative parameters. We aimed to assess whether exposure to Cd would adversely affect superior mammal SC viability and function. We isolated and purified SC from pre-pubertal pig testes according to our method and incubated the retrieved cells with three different Cadmium chloride concentrations (5-10-15 microM). Parameters of SC function such as inhibin B and anti-Mullerian hormone (AMH) were depressed by Cd exposure, contrary to what observed in untreated controls. No impairment of the FSH receptor integrity on the SC, as assessed by 17-beta-estradiol production, upon stimulation with FSH, was observed in either 5 microM Cd-treated or untreated controls. Differences, on the contrary, were observed for higher Cd concentrations (10 and 15 mM), in terms of FSH receptor integrity, that was altered, as compared to untreated controls, in terms of lower production of 17-beta-estradiol. In addition, the apoptotic test showed a significant increase of early (ANNEXIN V-/Propidium Iodide+) (AV-/PI+) and late apoptotic cells (AV+/ PI+) in all Cd -treated SC conditions as compared to controls. In conclusion, the Cd -related toxicity on SC, clearly demonstrated by our study, even at low concentrations, is expected to damage spermatogenesis that directly is dependent upon retention of SC viability and function.

Silica particle size and shape: in vitro effects on extracellular matrix metabolism and viability of human bronchial epithelial cells

Crystal micro-morphology and dimension of silica particles could be responsible for the high prevalence of silicosis as recently found among goldsmiths. In the present study we investigated two samples of silica particles with different surface sizes and shapes for their capacity to induce changes in ECM component production. In addition we investigated if their different effects could be related to cytotoxicity and apoptotic effects. Human bronchial epithelial cells were cultured with or without a sample of Silica used for casting gold jewellery, named in our experiments Silica P or a commercial sample of Silica with different physical and chemical properties, named in our experiments Silica F. After 48 h of exposure PCR analysis determined levels of several matrix components. As induction of the apoptosis cascade, annexin assay, caspase 3 activity and cellular cytoxicity by MTT assay were assayed. Silica F promoted fibronectin, MMP12, tenascin C and Integrins b5 gene expressions more than Silica P. Silica P stimulated more TGFß1 and its TGFßR1 receptor than Silica F. Cytotoxic effects were induced by the two samples of Silica. On the contrary, no alteration in classic apoptotic marker protein expression was observed in presence of either Silica F or Silica P, suggesting silica particles affect ECM production and metalloproteases through a mechanism that does not involve apoptotic activation. Different Silica micromorphology and TGFß signal pathway are linked to lung fibrotic effects but the potential role Silica in apoptotic and toxic reaction remains to be ascertained.

[Epidemiological evidence of possible musculoskeletal, cardiovascular and neoplastic effects in professional drivers]

The road and rail transport sector, since the several work tipology and risk factors for workers safety and health, is an area where assessing exposure effects is very difficult. Muscoskeletal cardiovascular and neoplastic diseases are the disorders more frequently associated to professional drivers. The role of professional driving is rather well-defined in low back pain occurence, correlated to whole body vibration exposure. Professional drivers are at higher risk of ischemic cardiovascular diseases, but it is not clear whether the risk is attributable just to the occupational exposures or also to their life-style risk factors. Evidence of an excess of risk for lung, genito-urinary and hemolymphopoietic cancer is clear in the scientific literature for professional drivers. Anyway the lack in the control of confounding factors, in exposure assessment force to be very cautious in results interpretation.

[Reduction of tobacco smoking among physicians of a hospital in central Italy]

This study assessed the variations in smoking habit in physicians in a General Hospital in Central Italy in 12 years. Data were collected from medical records of workers who underwent health surveillance in 1998-99 and in 2010-11. The prevalence of smokers was 26.3% (male 25.6%, female 27.6%) in 1998-99 and 19.2% (male 19.8%, female 18.5%) in 2010-11. As compared to 1998-99, the prevalence of smokers in 2010-11 was reduced in both sex and in all age classes. Despite the relevant reduction, the prevalence of smokers among physicians remains still high. Occupational physicians could play an important role against tobacco smoking, as they can provide a brief counseling to all smoking physicians during medical health surveillance at workplace and take part in worksite health promotion programmes.

[Prolonged exposure to crystalline silica Min-U-Sil-5 influences apoptosis or extracellular matrix genes expression in human bronchial epithelial cells]

Crystalline silica (Min-U-Sil-5) induces oxidative stress in human bronchial epithelial cells (BEAS-2B), through the intracellular accumulation of ROS that cause oxidative damage leading to the degradation of extracellular matrix (ECM) proteins and to the loss of cell adhesion molecules inducing apoptosis and genotoxic damage. This paper briefly summarizes some of the recent findings from our laboratories with emphasis on the molecular events by which the cronic and cumulative exposure to crystalline silica can induce cellular damage that promotes changes in extracellular matrix and in apoptosis gene expression.

[Are targeted interventions needed in foreigner workers with latent tubercular infection? A study on anti-tubercular treatment compliance among health care workers]

INTRODUCTION

Health care workers (HCWs) are at high risk of latent tubercular infection (LTBI). In this study predictors of anti-tubercular treatment interruption in HCWs with LTBI are evaluated.

METHODS

1056 HCWs with LTBI were followed up to register adverse events and predictors of treatment interruption.

RESULTS

289 workers did not complete the treatment. Predictors of treatment interruption were adverse events (OR 1.47; 95CI% 1.07-2.03) and to be born in South-America (OR 1.55; 95CI% 1.06-2.26).

CONCLUSION

The higher risk in South-Americans supports the need of targeted formative interventions on these workers.

[Smoking in the workplace: role of occupational physicians]

In many industrialized countries smokers have been observed in high prevalence among workers with poor educational status, who are usually exposed to major occupational risks. The smoking habit and passive smoking may by themselves, or through interactions with other occupational risk factors, cause the onset of serious diseases. Therefore health reasons and the legal obligation to observe the smoking ban in the workplace make it essential to prevent and combat smoking in the workplace and to promote smoking cessation in workers who smoke. This initiative should benefit not only workers' health and well-being but also company finances. The Occupational Physician should engage in diverse activities ranging from encouraging young people not to start smoking to providing programmes to encourage workers who smoke to abandon the habit. For example, he or she should i) inform managers, supervisors and workers about the high risks linked to smoking, passive smoking and obligations established by law ii) collect information about the smoking habit among workers and supply workers with the so-called minimal clinical intervention during routine health surveillance appointments and iii) collaborate with specific health promotion programmes in the workplace.

[Occupational accidents, work performance and obstructive sleep apnea syndrome (OSAS)]

Although many patients with obstructive sleep apnea syndrome (OSAS) form part of the work force, the impact of OSAS on occupational accidents and on work performance is unclear. To address this issue, we investigated 100 referents workers without OSAS (50 blue-collar and 50 white-collar) and 331 workers affected by OSAS (144 blue-collar and 187 white-collar). Workers affected by OSAS had been involved in occupational accidents more often than referents (27.2% vs. 20%). The mean number of accidents/year was slightly higher in blue-collar workers with OSAS and significantly higher (p=0.013) in white-collar workers with OSAS than referents. Furthermore, workers with OSAS referred more impairments in work performance as difficulties in memory (p=0.000), vigilance (p=0.000), concentration (p=0.000), performing monotonous tasks (p=0.000), responsiveness (p=0.000), learning new tasks (0.006) and manual ability (p=0.023), with the mean number of impairments being higher (p=0.000) in workers with a more severe OSAS (referents = 0.32; mild OSAS = 1.11; severe OSAS = 1.70). These results suggest OSAS increases the risk of occupational accidents and impaired work performance. Given the impact of OSAS on fitness for duty assessment, occupational physicians should be aware of it and could play a strategic role in its diagnosis, in monitoring treatment, and in providing appropriate information.

[Smoking ban observance in a general hospital]

Passive smoking is one of the main risk factors for severe chronic diseases. Hospitals are appropriate settings for promoting tobacco smoking cessation and preventing passive smoking. Moreover, since 2003 Italian Law (no 3/2003) forbids smoking in enclosed workplaces. The smoking ban should be strictly observed in hospitals. This study assessed smoking ban observance and exposure to ETS in a group of paramedical personnel working in a General Hospital (n=1037). Each subject answered a self-administered questionnaire. The prevalence of smokers was 31.2% in females and 31.5% in males. 83% of non-smokers and 66.6% of smokers approved the smoking ban in the hospital but 39.6% of non-smokers and 17.4% of smokers stated it was not observed. Percentages of, respectively, 57.0% and 31.1% in 2004 had dropped in 2005 and in 2006, after Law no 3/2003 was implemented. More than 90% of paramedical personnel declared that workers usually smoked in the workplace. 11.1% of non-smokers reported they were often exposed to ETS and 50% sometimes. These result show the smoking ban was not fully observed in the Hospital, where many workers reported they were exposed to ETS. Occupational Physicians should encourage health workers to stop smoking by offering appropriate counselling.

[Crystalline silica can induce oxidative stress by inhibiting glyoxalase system in bronchial epithelial cells]

Chronic inflammation and reactive oxygen species (ROS) production induced by crystalline silica are involved in the development of silicosis and lung cancer pathogenesis. ROS can generate lipid peroxydation of cell membranes that can produce methylglyoxal (MG), a strong cell proliferation inhibitor and apoptosis inducer. MG is naturally removed by glyoxalase I (GI) and glyoxalase II (GII) through a glutathione (GSH) dependent mechanism. Therefore mRNA expression of glyoxalases is correlated to MG concentration and oxidative stress.

OBJECTIVES

evaluate oxidative stress induced by crystalline silica by glyoxalases mRNA expression and methylglyoxal concentration

MATERIAL AND METHODS

In bronchial epithelial cell culture (BEAS-2B), exposed to 50 microg/cm2 crystalline silica (Min-U-Sil 5), for 2, 6, 12, and 24 hours, GI and GII mRNA levels and MG intracellular concentration were measured respectively by Real-Time PCR and HPLC.

RESULTS

Crystalline silica exposure induced a significant reduction in mRNA expression of glyoxalases and an increase of MG intracellular concentration.

CONCLUSIONS

The results suggest a possible use of MG and mRNA expression of GI and GII as crystalline silica induced oxidative stress indicators.

[Smoke habit in a population of apprentices in middle of Italy]

This study assessed the smoking habit in 7,159 apprentices (females: 53.3%) in central Italy. In the period 1996-2006, each apprentice underwent a compulsory health examination to assess fitness for work carried out by specialists in Occupational Medicine. Demographic data and information on schooling, smoking habit, alcohol and coffee intake were collected by a questionnaire. Overall, 51.9% of apprentices were smokers. Smokers were fewer among female apprentices than among the males (48.3% vs 55.9%; chi-square test, p < 0.001). No decrease in the prevalence of smokers was evident during the study period. Low educational level, and daily intake of alcohol and coffee significantly increased the risk of being a smoker. Finding a high percentage of smokers among Italian apprentices with a low educational level who are employed in jobs for which few qualifications are required indicates the need for work-place activities against tobacco smoking habit. Specialists in Occupational Medicine who perform regular health surveillance of workers could play a role in the anti-smoking campaign by integrating their routine work with brief counselling sessions aimed at preventing smoking in young workers and helping smokers to stop and by collaborating in work-place health promotion programmes.

[Urinary 1-naphthol in the general population of Umbria]

INTRODUCTION

Naphthalene, the most volatile polycyclic aromatic hydrocarbon (PAH), was recently classified as possible human carcinogen by International Agencies for Research on Cancer Humans may be exposed to naphthalene from a wide variety of sources, including occupation, environment, personal habits. We assessed urinary excretion of 1-naphthol (1-NAF), biomarker of naphthalene exposure, in non-occupationally exposed subjects.

MATERIALS AND METHODS

Urinary 1-NAF, 1-hydroxypyrene (1-OHP), biomarker of exposure to pyrene and cotinine, biomarker of smoking habits, were measured in 104 adults (53 men, 51 women).

RESULTS

1-NAF concentrations overlapped in males and females (median: men 0.35 Microg/g creat; women: 0.46 microg/g creat). Median concentration of 1-NAF was 6-fold higher in smokers compared to nonsmokers (respectively, 7.7 microg/g creatinine vs 1.3 microg/g creatinine). Between smokers, urinary cotinine was positively correlated to 1-naphthol (rho: 0.69; p < 0.01) and 1-OHP (rho: 0.53; p < 0.01). Higher 1-OHP concentrations were found in smokers (median: smokers 0.16 microg/g creatinine, not-smokers 0.05 microg/g creatinine;).

CONCLUSIONS

In our study population, we found that 1-NAF excretion is much higher as compared to 1-OHP excretion. This is due to the ubiquitous presence of naphthalene in the environment. Smoking considerably increase the exposure to naftalene.

Comparative in vitro studies on the fibrogenic effects of two samples of silica on epithelial bronchial cells

The small dimension and particle shape of silica in gypsum used to prepare moulds for lost wax casting might be responsible for the high prevalence of silicosis in gold jewellery. To test this hypothesis, human pulmonary epithelial cell (BEAS-2B) cultures were exposed to two samples of silica with different crystal micro-morphologies: Silica Powder (Silica P) which is used in casting gold jewellery, and no powder Silica (Silica F). Extracellular matrix (ECM) production was evaluated using radio-labelled precursors and quantified by RT-PCR analysis. Expression of basic fibroblast growth factor (FGF2) and its receptor (FGFR2) was also evaluated. The results demonstrated Silica P particles had a very fine lamellar crystalline structure while Silica F was characterized by larger rounded crystals. Silica P stimulated collagen production significantly more than Silica F and downregulated laminin and metalloprotease expression. Both silica samples down-regulated FGF2 but only Silica F enhanced FGF2 receptor expression. In conclusion each Silica sample promoted a profibrotic lung microenvironment in a different manner and also elicited different FGF2 signalling pathways. The data confirm that different micromorphology of Silica particles affects the fibrogenic potential and the molecular mechanisms of dust pathogenicity.

Induced sputum, exhaled breath condensate and nasal lavage fluid in electroplating workers exposed to chromium

Occupational exposure to chromium may cause airway inflammation and bronchial asthma. In this study we investigated the effect of chromium on the respiratory tract of exposed and non-exposed electroplating workers using spirometry and analysis of induced sputum (IS), exhaled breath condensate (EBC) and nasal lavage fluid (NLF). In both groups spirometry was normal; chromium in induced sputum was higher in exposed workers (7.90 +/- 0.855 microg/L, vs 1.78 +/- 0.075 microg/L; p<0.001); no significant difference was found in induced sputum cellularity. Median nitrite concentration in EBC was significantly higher in exposed subjects (4.35 micromol/L, 5 degrees -95 degrees percentile: 1.88-10.13 vs 0.11 micromol/L, 5-95 percentile: 0-0.72) (p<0.001). IL-6 and TNF-alpha were not detectable in EBC. Median IL-6 concentration in nasal lavage fluid was higher in exposed workers (5.72 pg/ml, 5-95 percentile: 0-65.25 pg/ml vs 0.28 pg/ml, 5-95 percentile: 0-1.7 pg/ml) (p<0.01). No differences in Eosinophil Cationic Protein concentration were found. TNF-alpha was not detectable in NLF. Chromium in induced sputum correlated with nitrites in EBC. For the first time three non-invasive methods were used to assess changes in respiratory tract in workers exposed to chromium. The results suggest chromium exerts an inflammatory/irritative action on airways.

[Respiratory diseases in confined non-industrial working environments]

Modern, non-industrial workplaces may, because of building techniques, widespread use of synthetic materials and artificial ventilation, create risks for the health and well-being of workers. Indoor air pollution by chemical, biological and sometimes physical agents constitutes a significant risk factor, particularly for the respiratory system. The most common effects of exposure to, and inhalation of, indoor air pollutants include acute and chronic inflammations, acute worsening of pre-existing respiratory symptoms or illnesses and airway sensitization to indoor allergens. Upper airway disturbances with an allergic or irritative aetiology are very frequent; Asthma and Hypersensitivity Pneumonitis are more rarely reported but may become severe and widespread when certain environmental conditions prevail. Respiratory infections may have a human source such as tuberculosis or viral diseases or may originate in ventilation systems such as Legionnaire's disease (Legionella pneumophila pneumonia). As all these pathologies may have high social and economic costs and appropriate therapy is not always available, the specialist in Occupational Medicine plays a pre-eminent role in early diagnosis and prevention of respiratory diseases linked to indoor air pollution in the workplace.

Clinical and diagnostic features of upper extremity work-related musculoskeletal disorders

Upper extremity work-related musculoskeletal disorders, (UE-WMSDs) are one of the major causes of work-related disability in industrialized countries. Diagnostic criteria for many UE-WMSDs are still under debate, and several different national and international studies have attempted to reach a consensus agreement on the minimum criteria for case definition of UE-WMSDs. This paper describes clinical and diagnostic features of UE-WMSDs, focussing on carpal tunnel syndrome and rotary cuff tendinopathy.

Indoor air quality and health in offices and other non-industrial working environments

BACKGROUND

Over the last 30 years, transformation of indoor environments--in particular in office blocks--has been associated with complaints from workers of discomfort, malaise and even diseases termed Building Related Illnesses (BRI) which are classified as specific (e.g. Legionnaire disease, asthma, hypersensitivity pneumonia) or non-specific (e.g. the Sick Building Syndrome).

METHODS

A review was made of data from international public health organisations, epidemiological, clinical and experimental studies and congress proceedings from 1990 to 2006 on the topic of indoor air quality and health in modern, non-industrial workplaces.

RESULTS

Studies focused on ventilation, temperature and air humidity and specific pollutants such as Volatile Organic Compounds, particules asbestos fibres, environmental tobacco smoke, radon and biological agents. We can now measure microclimate parameters and many indoor air pollutant levels as well as their effects on health; we can also formulate indications of threshold and guideline values for some of these and make a preventive assessment for toxic emissions from construction and furnishing materials. A stepwise, multi-disciplinary approach--with the specialist in occupational medicine playing a major role--is most suitable for dealing with BRI and the effects of poor indoor air quality on health.

CONCLUSIONS

Better criteria are needed to study emission of substances into the indoor environment, adequacy of ventilation, additive or synergistic effects of mixtures of chemicals and toxicity of micro-organism decomposition products. Objective clinical tests to assess the effects of indoor pollutants on health and indices for Indoor Environmental Quality in assessing buildings need to be improved.

Lead poisoning caused by Indian ethnic remedies in Italy

BACKGROUND

Complementary or alternative medicine has become widespread in Western Countries and since the remedies are "natural" they are believed to be free of toxic effects and health risks. Ethnic remedies may contain lead, other metals and toxic substances.

OBJECTIVES

To show how lead poisoning as a result of using ethnic remedies may be severe enough to cause serious damage to health, and to increase awareness among family doctors and occupational physicians of the risks associated with ethnic remedies.

METHODS AND RESULTS

Description of ethnic remedy-related lead poisoning in 2 native Italian adults, with clinical, laboratory and toxicological data.

CONCLUSIONS

When metal poisoning is diagnosed, ethnic remedies should be included among the putative sources so as to avoid erroneous attribution to workplace exposure and application of unneeded preventive measures.

[Report on the activities carried out in the research project of the Ministry of Instruction, University, and Research entitled "Environmental and occupational exposure to inorganic lead: assessment of toxic effects of current doses and related preventive measures"]

It is here presented the project sustained by the Ministry of Public Instruction, University and Research "Environmental and Occupational Exposure to Inorganic Lead: assessment of human health effects due to current doses and preventive measures" ruled out between 2001 and 2003. The aim of the study was to investigate about the toxic effects related to current occupational exposures to inorganic lead (particularly those effects concerning blood pressure, carcinogenic risk, nervous and immunological systems), to identify hypersusceptibility conditions, particularly the ALAD genetic polymorphism and to evaluate the role of traditional biomarker and the possibility of introducing new ones. In the present article the procedures followed during the project lasting and the contribution of each Unit are described. The results of the research, presented in detail in the current issue, do confirm the inadequacy of the biological exposure index nowadays ruled by Lex 25/2002.

[Effects of inorganic lead exposure on the autonomic nervous system and on the variability of heart rate among workers at a battery plant]

Inorganic Lead can cause a toxic effect on Central Nervous System, Peripheral Nervous System and Autonomic Nervous System (ANS). A damage of the ANS can determine an heart rate variability (HRV) reduction. In this study 43 battery workers exposed to inorganic lead with mean PbB = 31.63 microg/dl (DS 14.77 microg/dl) and 35 not exposed subjects underwent to an evaluation of heart rate variability by specific tests. Heart rate variability in the exposed group was, for some tests (lying to standing, lying to standing-standing to lying) reduced compared with not exposed subjects and for other tests (Valsalva manouvre, lying to standing-standing to lying) correlated with PbB and Zinc Protoporphyrin (ZPP), but not with BMI, age and smoking habits. This study, like others conducted on similar populations, suggest an effect of occupational inorganic lead exposure on Autonomic Nervous System and heart rate variability

[Lead: indicators of dose and effects on heme]

In the present study the role of the traditional biomarkers of exposure and effect on haeme system during lead exposure was analysed: the opportunity of introducing new biomarkers such as lead and delta-aminolevulinic acid in plasma was also evaluated, especially by considering the current levels of exposure. The population in study was constituted by 371 males owning to different production fields and selected by five national units. The results suggest caution in the use of lead in plasma as a biomarker of lead exposure in the biological monitoring procedures, mainly in reason of its great variability affecting in particular the sampling time and the pre-analytical treatment of the sample. The other biomarkers were well correlated between them and with the exposure biomarkers for lead in blood >300 microg/L, suggesting the BEI to which the protection of workers exposed to lead would be guaranteed (instead the actual of 600 microg/L).

[ALAD polymorphism and indicators of dose and effects of occupational exposure to inorganic lead]

The delta-aminolevulinate dehydrase (ALAD) genetic polymorphism was investigated along with biomarkers of lead exposure and effect on 333 male workers, occupationally exposed to lead, with blood lead levels (PbB) higher than 100 microg/l. ALAD genotype frequencies were distributed as expected among Caucasians. Workers bearing at least one ALAD-2 allele showed PbB values slightly higher than those from ALAD-1-1 subjects, who also exhibited higher urinary delta-aminolevulinic acid (ALAU) and blood zinc protoporphyrin (ZPP) levels. The plasmatic lead (PbP)/PbB ratio was similar in both groups. Exposure and effect biomarkers were significantly each other correlated among ALAD-1-1 subjects only, who showed also a significant inverse relationship between ALAD activity and ZPP values. Results confirm previous studies, supporting the hypothesis that ALAD polymorphism may interfere with toxico-kinetic and toxico-dynamic parameters of occupational exposure to Pb.

[Chemical pollution of indoor air and its effects on health]

Many studies have demonstrated how exposure to chemical pollutants in indoor air has adverse effects on health and comfort. Volatile organic compounds (VOCs), formaldehyde, ozone, particulates, fibres and environmental tobacco smoke have all been implicated. VOCs include a wide range of chemical substances which irritate mucosa. Many are neurotoxic and some are suspected or known to be carcinogenic e.g. benzene. Formaldehyde, the simplest and most common aldehyde in indoor air, is a powerful irritant to the skin, eyes, nose and upper airways. Given its close association with nasal-pharyngeal tumours, it has recently been classified as a certain carcinogen for humans. Exposure to ozone may cause airway irritation and inflammation, reduce the ventilation function and increase reversible bronchial reactivity. In the general population it increases the mortality rate and the number of hospital admissions for respiratory diseases. Airborne particles, a mixture of organic and inorganic substances, are powerful irritants for the eyes and mucosa and can cause adverse cardiovascular effects. Apart from indoor environments, exposure to asbestos fibres has been associated with an increased risk of respiratory diseases such as pneumoconiosis lung cancer and mesothelioma. Synthetic mineral fibres cause transient irritation and inflammation of the skin, eyes and upper airways. Recent observations have confirmed that exposure to environmental tobacco smoke, which is widespread in workplaces, increases the risk of lung cancer, irritative respiratory and ocular symptoms and cardiovascular diseases.

[Indoor air quality: suggestions for risk assessment and medical surveillance]

This paper presents indications for investigations and health surveillance in indoor environments. The study of the indoor air quality consists of the following phases: acquisition of the necessary information about the indoor environment; sampling strategy and techniques; qualitative and quantitative analysis of contaminants such as particulate, CO2 and CO, NOx, volatile organic compounds, biological agents. The proposed health surveillance is articulated on four lines: periodical health surveillance, when already performed for other risks (e.g. VDT); specific clinical examinations in occasion of particular events; use of a questionnaire for the evaluation of comfort of the workers; health promotion. A team approach, with cooperation between technical and medical experts, is recommended both for periodical risk assessment and when it is necessary to solve specific indoor problems.

[Evaluation of the effects of occupational noxae on the cardiovascular system]

BACKGROUND

Working conditions and the environment may contribute to the multi-factorial aetiology of cardiovascular disease.

OBJECTIVES

To provide a critical assessment of epidemiological and clinical methods and tools for evaluating the effects of occupational pathogenic noxae on the cardiovascular system.

METHODS

A review was made of epidemiological and clinical studies published in the main scientific journals of occupational medicine and cardiology, in the period 1980-2003. Data sources were electronic medical data bases and conference proceedings.

RESULTS AND CONCLUSION

Collecting case histories by means of free or questionnaire-structured interviews, observing specific physical signs, detecting changes in blood chemistry parameters and identifying morphological or functional abnormalities in the heart and vessels are all useful approaches. Some blood chemistry parameters that may be modified by occupational exposure or by particular conditions arising from work organization are cholesterol, triglycerides, apolipoproteins A and B, platelets, fibrinogen, factor VIIc, fibrinolysis products, plasminogen tissue activating factor, complement and glycated hemoglobin. They can all be measured easily and quickly and provide an estimate of the risk of cardiovascular disease. As high blood pressure is closely correlated to heart disease, blood pressure levels can be monitored in a working population using a standard mercury sphygmomanometer. Electronic measurement before and after a work shift and 24 hour Holter monitoring help reduce the "white coat effect" and provide further useful information. Occupational risk factors such as toxins (metals, solvents, pesticides), electromagnetic fields, extreme temperatures, noise, radiation and psychophysical stress can affect the cardiac neuro-autonomic balance of the exposed workers and cause cardiovascular abnormalities. These can be detected by long-term ECG monitoring, and are revealed as reduced heart rate variability and prolonged QT interval. Recently non-invasive systems have been adopted to detect cardiovascular lesions that are usually due to atherosclerosis. In occupational and environmental studies ultrasound measurement of intima-medial carotid thickness and brachial artery reactivity have been used to determine the effects of exposure to carbon disulfide and passive smoking. Occupational Medicine has yet to include the use of the very expensive electron-beam computed tomography for a rapid and non-invasive study of coronary artery disease.

[Excellency accreditation by the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII)]

BACKGROUND

The Italian Society for Occupational Health and Industrial Hygiene (Società Italiana di Medicina del Lavoro e Igiene Industriale)--SIMLII--has taken a systematic approach to the topic of permanent education of occupational health physicians over the last 4 years, developing its own project entitled "SIMLII Permanent Education and Excellency Accreditation".

OBJECTIVES

The SIMLII Project, which is addressed to occupational health specialists and physicians authorized under Law 277/91, art. 55, is based on the participation of "obligatory" and "non-obligatory" educational activities and on assessment of professional activity. "Obligatory" educational activities are events organized directly by SIMLII and consist of a detailed study of the guidelines concerning specific occupational health topics. The "non-obligatory" events are those regarding occupational health that the physician chooses voluntarily, with accreditation by the Ministry of Health and/or by SIMLII. The occupational health physician who enrolls for the 3-year course must obtain a total of 180 SIMLII training credits in the 3 years (60 per year). Assessment of activity performed is made at the end of the 3 years of training according to criteria set out by SIMLII and approved by the membership, via a self-administered questionnaire.

METHODS AND RESULTS

The SIMLII Project has laid great emphasis on drawing up guidelines on topics specific for occupational health. These guidelines are developed by groups of experts selected by SIMLII and deal with topics that the occupational health physician most frequently encounters in the course of his/her professional activity. There are 405 participants in the first 3-year training course covering the whole of Italy. The aim of the Italian Society for Occupational Health and Industrial Hygiene, via excellency accreditation and drawing up of guidelines for particularly important topics, is to provide useful tools to satisfy the training requirements of its membership, to improve the quality of professional services and to emphasize the uniqueness and specific nature of occupational health within the medical specialties.

[Implementation of parliamentary act D. Lgs 25/02 and definition of "moderate risk"]

This paper describes the position of the Joint Working Group of the Italian Association of Industrial Hygienists (AIDII), the Italian Society of Occupational Health and Industrial Hygiene (SIMLII) and the Italian Society of Toxicology (SITOX) on "Analysis of Parliamentary Act D.Lgs 25/02 and role of the Scientific Societies in the definition of Limit Values". The positive aspects of the new law which implements the European Directive 98/24 are discussed, including the abolition of the rigid periodicity of medical examinations as stated by the old rule D.P.R. 303/56. The Authors also address various parts of the law which appear to be unclear and controversial and highlight the expected difficulties arising for the employers and the safety and health professionals during the application of this new piece of legislation. Moreover, a number of discrepancies are noted between the new Italian law and the original Directive or other current Italian rules such as i. the translation of the term "slight risk", as from the original Directive, into "moderate risk", and the resulting non compulsoriness of health surveillance and biological monitoring of the workers in presence of a "moderate risk", ii. the concurrent exclusion, under the same circumstances, of the occupational physician from risk assessment procedures and iii. the upward modification of the previously established (D.Lgs 277/91) occupational exposure limits for lead. Moreover, the Authors examine and criticize--both in semantic and in toxicological terms--a recent proposal for the definition of "moderate risk" made by an ad hoc Consulting Committee of the Labour Ministry, in which the term "moderate" has been interpreted either as "low" or as "irrelevant for health effects", clearly two very different meanings. Besides, it would be inappropriate to define the conditions of a moderate risk based only on the level of exposure to the chemical (expressed as a fraction of the corresponding limit value), without considering the two other components of risk assessment for that chemical (hazard and susceptibility). Even worse would be the use of simplified models based on "algorithms", which might be useful in a preliminary phase of risk assessment, but easily could lead to an under- or over-estimation of risk, particularly when used by non professionals. In conclusion, the Working Group recommend that the new law be amended in order to clarify its most controversial aspects, whose misinterpretation could severely jeopardize the protection of the workers' safety and health at work.

Primary DNA damage in chrome-plating workers

In order to evaluate the primary DNA damage due to occupational exposure to chromium (VI), DNA strand-breaks and apoptosis in peripheral lymphocytes were measured in a group of 19 chrome-plating workers. DNA strand-breaks was assessed by alkaline (pH>13) single-cell microgel electrophoresis ('comet') assay, while apoptosis was measured by flow-cytometry after propidium iodide staining of the cells. Concentrations of chromium in urine, erythrocytes and lymphocytes were investigated as biological indicators of exposure. A group of 18 hospital workers (control group I) and another 20 university personnel (control group II) without exposure to chromium were also studied as controls. The results of the study show that chrome-plating workers have higher levels of chromium in urine, erythrocytes and lymphocytes than unexposed workers. Comet tail moment values, assumed as index of DNA damage, are increased in chromium-exposed workers and results are significantly correlated to chromium lymphocyte concentrations. No difference emerged in the percentage of apoptotic nuclei in exposed and unexposed workers. The study confirms that measurements of chromium in erythrocytes and lymphocytes may provide useful information about recent and past exposure to hexavalent chromium at the workplace. The increase in DNA strand-breaks measured by comet assay suggests this test is valid for the biological monitoring of workers exposed to genotoxic compounds such as chromium (VI).

Systemic nicotine exposure in tobacco harvesters

Several epidemics of nicotine intoxication have been described among tobacco harvesters; however, little is known about nicotine absorption under typical working conditions. To assess systemic nicotine absorption during a regular working shift, the authors performed an observational field study. Included in the study were 10 healthy, nonsmoking, female tobacco harvesters and a control group of 5 healthy, nonsmoking, female hospital workers. Nicotine and cotinine were measured in sequential samples of blood and urine during a regular workshift. Blood nicotine levels rose from a nadir value of 0.79 +/- 0.12 ng/ml to a peak value of 3.45 +/- 0.84 ng/ml (p < .05 [Tukey's modified t test]) in the exposed group. In the control group, levels were stable at 0.1 +/- 0.1 ng/ml (p < .01). Moreover, the mean blood nicotine level measured 3 mo following the end of exposure in 6 of 10 exposed subjects was 0.24 +/- 0.12 ng/ml (p < .01). Corresponding higher values of urine nicotine and urine cotinine were observed in the exposed versus control group (comparative p values were < .01 and < .05, respectively). Overall, tobacco harvesters absorbed approximately 0.8 mg of nicotine daily. Given that nicotine can induce adverse health effects, the authors believe that prevention of nicotine absorption in tobacco harvesters should be sought and that workers should be informed about occupational risks.

Silica and its antagonistic effects on transforming growth factor-beta in lung fibroblast extracellular matrix production

BACKGROUND

Silicosis, a pneumoconiosis marked by interstitial pulmonary fibrosis, is caused by inhalation of free crystalline silica particles. When silica particles are injected into the lower lung, they are translocated across the epithelium into the interstitial space, where macrophage-derived growth factors affect lung fibroblast proliferation and collagen deposition. We hypothesized that silica may act directly on pulmonary fibroblasts modifying extracellular matrix (ECM) synthesis and that the effects of silica may be mediated by transforming growth factor-beta (TGFbeta) overproduction.

METHODS

To test this hypothesis, we studied a human lung fibroblast cell line (WI-1003) exposed to silica in vitro. We investigated cell morphology by electron microscopic procedure, cell growth, collagen production, and glycosaminoglycans (GAG) composition by radiolabeled precursors. Cytokine and growth factor synthesis were evaluated by specific enzyme-linked immunoadsorbent assay kits and Northern blotting analysis.

RESULTS

Pulmonary fibroblasts internalized silica particles without detectable cell damage. Silica directly stimulated collagen synthesis and decreased the amount of 3H-glucosamine-labeled GAG. Silica-treated fibroblasts secreted less TGFbeta than untreated controls, antagonized the stimulatory effect of TGFbeta on ECM synthesis, and reversed TGFbeta-induced inhibition of cell proliferation. Northern blotting analysis showed increased interleukin-1alpha (IL-1alpha) mRNA after silica treatment. IL-1alpha had no influence on collagen synthesis but increased the number of WI-1003 fibroblasts.

CONCLUSIONS

These results support our hypothesis that lung fibroblasts are direct silica targets. However, contradicting our hypothesis, silica antagonized TGFbeta activities through a TGFbeta downregulation and an IL-1alpha upregulation. The complex pattern of TGFbeta and IL-1alpha regulation in pulmonary fibroblasts is imbalanced by silica exposure and might play a key role in silica-mediated pulmonary fibrosis.

Bronchial epithelial cell matrix production in response to silica and basic fibroblast growth factor

BACKGROUND

Previous studies show that macrophages, lung fibroblasts, and their soluble mediators are responsible for the onset and development of pulmonary fibrosis. This study was conducted to determine whether airway epithelial cells are also directly involved in response to fibrogenic agents and consequently in the pathogenesis of lung fibrosis. To verify the hypothesis, we determined whether silica acts directly on human bronchial epithelial cells by stimulating cytokine and growth factor release and by modifying matrix production.

MATERIALS AND METHODS

An SV40 large T antigen-transformed human airway epithelial cell line, 16HBE14o (16HBE), was used. The expression profile of some proinflammatory interleukins (ILs), such as IL-1alpha, IL-1beta and IL-6 and their modulation by silica, were evaluated by polymerase chain reaction (PCR) analysis. Transforming growth factor beta (TGFbeta) and basic fibroblast growth factor (bFGF) mRNA levels were tested by Northern blotting in the presence and in the absence of silica. The silica- and/or bFGF-induced effects on matrix components (total proteins, collagen, and fibronectin) were also evaluated using radio-labeled precursors.

RESULTS

The results demonstrated 16HBE internalized silica particles. Silica induced a little IL-6 secretion, without affecting IL-1 and TGFbeta isoform production and strongly stimulated bFGF mRNA level and bFGF protein secretion. Silica also induced changes in 16HBE production of total proteins, collagen, and fibronectin production. When added in combination with the growth factor, it strengthened bFGF stimulation of matrix component secretion.

CONCLUSIONS

These results support the hypothesis that the changes in matrix components are due to a direct effect of silica on bronchial epithelial cells. Silica-induced over-secretion of bFGF suggests that autocrine and paracrine differentiation loops for bFGF may also be operative and that these mechanisms may be involved in the pathogenesis of pulmonary fibrosis. In the future, cytokine-directed therapeutic strategies might find a place in clinical practice.

[Smoking in the workplace. Study at a hospital in central Italy]

Smoking is the leading preventable cause of death and the source of numerous problems in the workplace. This study assessed the smoking in health care workers in a general hospital in Central Italy. As part of the health surveillance required by Law No. 626/1994, 2743 employers (40.8% males, 59.2% females; mean age 42.0 ys, SD 9.6 ys) were interviewed. The prevalence of smokers was very high: 36.0% in men and 36.7% in women. When the population was stratified according to occupation, the highest prevalence of smokers was found in ward orderlies (45.2%) and nurses (38.9%) and the lowest in doctors (26.3%). The prevalence of smoking was similar in all occupational divisions--clinical, surgery, diagnostics and administration. This study shows that smoking is more widespread in hospital workers than in an age-matched section of the general population (27.5%). As all health workers should set a positive example in combatting smoking, occupational physicians in charge of health surveillance in hospitals should actively collaborate in smoking dissuasion programmes.

Yellow nail syndrome: does protein leakage play a role?

Yellow nail syndrome is characterized by primary lymphoedema, recurrent pleural effusion and yellow discoloration of the nails. Although mechanical lymphatic obstruction is assumed to be the underlying pathology, it cannot explain the common finding of high albumin concentration in the pleural space. This paper describes a case of yellow nail syndrome presenting with the classical triad of lymphoedema, recurrent pleural effusion and yellow discoloration of the nails, associated with persistent hypoalbuminaemia and increased enteric loss of albumin. Based on the findings in this case and those in the literature, it is speculated that increased microvascular permeability may contribute to the pathogenesis of this syndrome.

[Health promotion in the occupational setting: what are the prospects in the Italian situation?]

Over the past decades advances in sciences and medicine have improved living and health conditions and lengthened life expectancy. These benefits are associated with an increase in prevalence of chronic degenerative diseases. With their multi-factorial aetiology these diseases are influenced by life styles and personal habits and require prolonged medical care and high social costs. Now days health is no longer considered as the absence of disease but a state of mental, physical and social well-being. The World Health Organization has defined health promotion as "the process of enabling people to increase control over and to improve health". Since the 70s in the USA many health promotion programmes have been proposed, especially by large corporations, in order to ensure a more efficient, productive and motivated work-force, to reduce health insurance costs and to provide a better company image. Workplaces,--particularly when the working population is relatively stable--are excellent areas for health promotion programmes because workers can be monitored over a long period of time. The most successful programmes are aimed at modifying behaviour in risk patterns (smoking, alcohol abuse, eating disorders, etc.) through information, active participation, screening, follow-up, personalized programmes, changes in the working environment, physical exercise programmes. These health promotion programmes are extremely hard to develop for Italian workers. Most firms are small or very small and much still remains to be done to eliminate well-known occupational risk factors. The current flexibility of modern work patterns could constitute a further obstacle.

Activity and isoenzyme profile of N-acetyl-beta-D-glucosaminidase in urine from workers exposed to cadmium

The urinary excretion of N-acetyl-beta-D-glucosaminidase (U-NAG) and urinary Cadmium (U-Cd) concentration, a measure of the metal load in the body, were evaluated in 28 workers exposed to Cd, to determine the relation between the two parameters. In urine from 22 exposed workers with U-Cd<2 microg/g creatinine (Cr) there was no significant difference in U-NAG value (0.98+/-0.59 U/gCr) compared to non-exposed (0.73+/-0.48 U/gCr). In the six workers with 2 microg/gCr < or =U-Cd<10 microg/gCr the U-NAG (2.32+/-0.61 U/gCr) was statistically (P<0.05) higher than in other workers. In both the U-Cd intervals examined there were no altered values of beta2-microglobulin from urine of exposed workers compared to non-exposed (<0.30 mg/l). The U-NAG isoenzymes were separated by DEAE-cellulose chromatography from urine of non-exposed subjects and exposed workers. The U-NAG isoenzyme profile in urine of non-exposed subjects showed a high percentage (about 95%) of the A (acid) form, a much lower percentage (about 4.5%) of B (basic) form and a negligible percentage (about 0.5%) of I (intermediate) form. In the urine of 22 exposed workers with U-Cd<2 microg/gCr, the percentages of U-NAG isoenzymes were not different from non-exposed. In the urine of six workers with 2 microg/gCr< or =U-Cd<10 microg/gCr the percentage (8.34+/-0.91) of isoenzyme B (U-NAG-B), a marker of lesional enzymuria, was statistically increased (P<0.05) compared to non-exposed (4.42+/-0.56). These results suggest that adopting a biological limit for U-Cd equal to 10 microg/gCr might not be sufficiently protective. The increase in U-NAG-B content at 2 microg/gCr<U-Cd</=10 microg/gCr is probably due to a lesion of the proximal tubule caused by the metal which might follow an induction of the apoptotic process.

Blood cadmium concentrations in the general population of Umbria, central Italy

The aims of this study were (a) to assess blood cadmium (B-Cd) concentrations and to establish a tentative reference interval; (b) to identify significant determinants of B-Cd, in a population from Umbria, Central Italy, which was not occupationally exposed to cadmium (Cd). Four hundred and thirty-four healthy blood-donors volunteered to answer a questionnaire and provide a blood sample for B-Cd analysis, which was performed by graphite furnace atomic absorption spectrophotometry. Blood Cd concentrations ranged from non-detectable values, i.e. below 0.1 microgram/l up to 3.4 micrograms/l and were not normally distributed. The median values and the 95th percentiles were 0.7 and 2.0 micrograms/l, respectively. Concentrations of B-Cd were more than double in smokers than in non-smokers, median values being 1.1 micrograms/l and 0.5 microgram/l, respectively. In current smokers, B-Cd values correlated with the number of cigarettes smoked daily (rs = 0.40, P = 0.0001) and with the cumulative exposure to cigarette smoke (rs = 0.35, P = 0.0001). Concentrations of B-Cd correlated with age in the non-smokers, but not in the smokers and were significantly higher in women than in men only in the non-smokers. Both in smokers and non-smokers, B-Cd concentrations were similar in subjects living in urban or in rural areas. In the whole study population the lower and the upper tentative reference limit were < 0.1 and 2.2 micrograms/l, respectively, as computed by a non-parametric rank-based method. The upper limit was approximately double in smokers than in non-smokers (3.1 micrograms/l and 1.6 micrograms/l, respectively). Our results show that B-Cd concentrations in a general population from Umbria are in the range reported for general populations in Northern Italy and other European Countries. Smoking was the strongest determinant of B-Cd concentrations and age had a lesser effect.

Prevalence of irritative symptoms in a nonproblem air-conditioned office building

OBJECTIVES

To assess the prevalence of work-related complaints and symptoms in employees in an air-conditioned office building (Building AC) in a mild climatic area (Italy). No discomfort had previously been reported.

METHODS

A total of 198 employees in Building AC and 281 controls working in three naturally ventilated buildings (Building NV) answered a questionnaire investigating work-related complaints and symptoms.

RESULTS

A significantly higher percentage of workers in Building AC reported a lack of comfort in the working environment as compared with the controls (30.6% versus 18.9%). The most common complaints were strong lighting, high temperature, and dry, dusty, and/or stuffy air. The prevalence of ocular, upper airway, and cutaneous symptoms was significantly higher (29.8% versus 14.9%, 25.3% versus 9.6%, and 14.1% versus 3.6%, respectively). No significant difference was observed in respiratory or general symptoms. Logistic regression analysis showed that working with video display units and photocopiers influenced ocular symptoms; upper airway and cutaneous symptoms were influenced by female gender and working in the air-conditioned building.

CONCLUSIONS

In an apparently healthy air-conditioned office building, complaints and symptoms are reported more often than in a naturally ventilated edifice, but the prevalence is lower than that usually observed in sick buildings. Symptoms are influenced by individual and work-related characteristics.

[Lead absorption in an Umbrian population from 1982 to 1992]

This report assessed lead absorption in community samples of the general population in Umbria, central Italy, in 1982 and in 1992. Each participant (128 subjects in 1982 and 479 in 1992) answered a questionnaire providing details of personal information and life style. Blood lead levels were determined by atomic absorption spectrophotometry. In 1992 hematocrit and glutamyltranspeptidase (gamma-GT) levels were also measured. In 1982 the mean blood lead level was 226 micrograms/l in males and 167 micrograms/l in females, and in 1992 it was still higher in males than in females (98 micrograms/l vs 61 micrograms/l) as were hematocrit and gamma-GT levels. Multiple regression analysis showed sex and age were the main factors accounting for 42% of the total variation in blood lead levels. They were followed by alcohol consumption, gamma-GT levels and smoking in this order. In conclusion, blood lead levels decreased significantly in central Italy in the decade 1982-92 and persistent lead absorption seems to be due to individual characteristics such as male sex, advanced age and a personal life style which includes alcohol consumption and smoking.

Objective assessment of ocular and respiratory alterations in employees in a sick building

BACKGROUND

Sick building syndrome (SBS) is a constellation of diffuse, "irritative" symptoms predominantly involving the eyes and the respiratory tract. To date, the effects of working in a "sick building" have not been adequately assessed using objective measures. We undertook the present study to determine whether objective alterations could be found in the eyes and respiratory' tracts of employees working in an office building in which a high rate of SBS had been reported in the preceding year.

METHODS

We studied 163 office workers: 87 workers from a modern, air-conditioned building (the sick building), and 76 employees employed in three traditional-style office buildings (the comparison buildings). After being surveyed for SBS symptoms, all subjects underwent a series of objective tests, including spirometry, a methacholine test, prick tests for aeroallergens, and submitted tear samples. In addition, Schirmer's test and the break-up time test were used to explore for potential ocular effects of sick building exposure.

RESULTS

Employees in the sick building complained more frequently of ocular symptoms, upper-airway disturbances, and general and respiratory' symptoms than did employees in the comparison buildings; prick tests were positive in 20% and 17.4%, respectively. Groups did not differ significantly on spirometry measures. Bronchial hyperreactivity to methacholine (PD15 = 16.348 mumol) was present in 20.5% of the sick building workers and in 16.2% of comparison buildings workers. Methacholine dose-response slope values were similar. Stability of tear film was significantly reduced (P < 0.01) in the employees in the sick building compared with employees in the comparison buildings.

CONCLUSIONS

Our results indicate that (1) atopy does not seem to influence the prevalence of SBS symptoms, and (2) the lower respiratory tract seems unaffected by exposure to a "sick building," but (3) alterations in tear film stability do exist after such exposure.

Preventive measures reduce exposure to polycyclic aromatic hydrocarbons at a graphite electrode plant

OBJECTIVE

This study assessed the efficacy of preventive measures in a graphite electrode plant aimed at reducing occupational exposure to polycyclic aromatic hydrocarbons (PAHs).

METHODS

Electrode workers (n = 146) answered a questionnaire and provided an end of shift urine sample. Urinary 1-hydroxypyrene (1-hpur), a biological marker of exposure to PAHs, was measured by high performance liquid chromatography coupled with: (a) fluorescence detection. 1-Hydroxypyrene concentrations were compared with the concentrations measured before implementing the preventive measures; and (b) those of a control group of 54 men not occupationally exposed to PAHs.

RESULTS

After implementation of preventive measures, median concentrations 1-hpur were significantly reduced in some groups of workers: by -24%, -37% and -30% in workers at the green electrode unit, one baking impregnation unit, and the laboratory, respectively. In workers at a second baking impregnation unit, in end product finishing and in the power station 1-hpur concentrations were unchanged. Urinary 1-hp concentrations were still significantly higher in each group of workers than in the control group (p < 0.001 for any comparison). Concentrations in the workers varied with the type of job, the highest values being found in workers engaged in the power station, in the two baking impregnation units and in the green electrode unit.

CONCLUSIONS

Implementing preventive measures significantly reduced exposure to PAHs at a graphite electrode plant. The reduction in median and peak concentrations of 1-hpur, which reflects total exposure to, and internal dose of PAHs, was most evident in workers employed in the units where preventive measures had been taken. Despite an overall reduction, further preventive measures are needed to minimise exposure to PAHs and consequently the risk of adverse health effects.

Long-term pulmonary and systemic toxicity following intravenous mercury injection

Long-term pulmonary and systemic toxicity following mercury intravenous injection has rarely been assessed. We present the results of a detailed investigation assessing pulmonary and systemic long-term toxic effects in a subject who had pulmonary and systemic mercury microembolism diagnosed more than 11 years previously. Radiographic examination showed the persistence of mercury microemboli in both lungs and elsewhere in the body. Lung function tests revealed a decreased diffusing capacity for carbon monoxide and PO2 probably indicative of microscopic inflammation of lung interstitium. Electroneuromyography showed signs of mild axonopathy in both legs. At semen analysis, a high proportion of motionless spermatozoa was present. Urinary excretion of mercury was high. Signs of interstitial lung impairment, peripheral axonopathy and asthenozoospermia in a subject who had mercury microembolism persisting for more than 11 years might be evidence of long-term mercury toxicity.