An Analysis of the Neutralizing Antibodies against the Main SARS-CoV-2 Variants in Healthcare Workers (HCWs) Vaccinated against or Infected by SARS-CoV-2

Although the anti-COVID-19 vaccination has proved to be an effective preventive tool, "breakthrough infections" have been documented in patients with complete primary vaccination courses. Most of the SARS-CoV-2 neutralizing antibodies produced after SARS-CoV-2 infection target the spike protein receptor-binding domain which has an important role in facilitating viral entry and the infection of the host cells. SARS-CoV-2 has demonstrated the ability to evolve by accumulating mutations in the spike protein to escape the humoral response of a host. The aim of this study was to compare the titers of neutralizing antibodies (NtAbs) against the variants of SARS-CoV-2 by analyzing the sera of recovered and vaccinated healthcare workers (HCWs). A total of 293 HCWs were enrolled and divided into three cohorts as follows: 91 who had recovered from SARS-CoV-2 infection (nVP); 102 that were vaccinated and became positive after the primary cycle (VP); and 100 that were vaccinated with complete primary cycles and concluded the follow-up period without becoming positive (VN). Higher neutralization titers were observed in the vaccinated subjects' arms compared to the nVP subjects' arms. Differences in neutralization titers between arms for single variants were statistically highly significant (p < 0.001), except for the differences between titers against the Alpha variant in the nVP and in VP groups, which were also statistically significant (p < 0.05). Within the nVP group, the number of subjects with an absence of neutralizing antibodies was high. The presence of higher titers in patients with a complete primary cycle compared to patients who had recovered from infection suggested the better efficacy of artificial immunization compared to natural immunization, and this further encourages the promotion of vaccination even in subjects with previous infections.

Basophil Activation Test in the Diagnosis of Anisakis Allergy: An Observational Study from an Area of High Seafood Consumption in Italy

The rising popularity of undercooked or raw seafood containing larvae of the Anisakis parasite has led to issues of public health concern due to allergic manifestations. We conducted an observational study on the use of an innovative Anisakis allergy diagnostic algorithm in a convenience sample of 53 allergic outpatients recruited in Western Sicily, between April 2021 and March 2022. We included individuals with an anamnesis suggestive of IgE sensitization to Anisakis reporting clinical manifestation in the last month due to allergic reactions after eating fresh fish, or in subjects at high exposure risk with sea products while abstaining from fish ingestion, excluding those with documented fish sensitization. Outpatients were tested via Skin Prick Test, IgE-specific dosage and Basophil Activation Test (BAT). Twenty-six outpatients were diagnosed with Anisakis, while 27 with Chronic Urticaria (CU). We found a seven-fold excess risk for Anisakis (p4) positivity in the Anisakis allergic outpatients, as compared to the CU ones. BAT showed the best diagnostic accuracy (92.45%) and specificity (100%), while specific IgE to Ascaris (p1) documented the best sensitivity (92.31%) but a very low specificity (37.04%). In conclusion, our findings may represent a potentially useful contribution to the future development of updated clinical guidelines.

Association Between Pollution and Frailty in Older People: A Cross-Sectional Analysis of the UK Biobank

OBJECTIVES

Frailty is a relevant issue in older people, being associated with several negative outcomes. Increasing literature is reporting that pollution (particularly air pollution) can increase the risk of frailty, but the research is still limited. We aimed to investigate the potential association of pollution (air, noise) with frailty and prefrailty among participants 60 years and older of the UK Biobank study.

DESIGN

Cross-sectional.

SETTINGS AND PARTICIPANTS

Older participants (age ≥ 60 years) participating to the UK Biobank.

METHODS

Frailty and prefrailty presence were ascertained using a model including 5 indicators (weakness, slowness, weight loss, low physical activity, and exhaustion). Air pollution was measured through residential exposures to nitrogen oxides (NO_x) and particulate matter (PM_2.5, PM_2.5-10, PM₁₀). The average residential sound level during the daytime, the evening, and night was used as an index for noise pollution.

RESULTS

A total of 220,079 subjects, aged 60 years and older, was included. The partial proportional odds model, adjusted for several confounders, showed that the increment in the exposure to NO_x was associated with a higher probability of being in both the prefrail and frail category [odds ratio (OR) 1.003; 95% CI 1.001-1.004]. Similarly, the increase in the exposure to PM_2.5-10 was associated with a higher probability of being prefrail and frail (OR 1.014; 95% CI 1.001-1.036), such as the increment in the exposure to PM_2.5 that was associated with a higher probability of being frail (OR 1.018; 95% CI 1.001-1.037).

CONCLUSIONS AND IMPLICATIONS

Our study indicates that the exposure to air pollutants as PM_2.5, PM_2.5-10, or NO_x might be associated with frailty and prefrailty, suggesting that air pollution can contribute to frailty and indicating that the frailty prevention and intervention strategies should take into account the dangerous impact of air pollutants.

SARS-CoV-2 Infection in Healthcare Professionals and General Population During "First Wave" of COVID-19 Pandemic: A Cross-Sectional Study Conducted in Sicily, Italy

On December 31, 2019, an outbreak of lower respiratory infections was documented in Wuhan caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the beginning, SARS-CoV-2 has caused many infections among healthcare workers (HCWs) worldwide. Aims of this study were: a. to compare the distribution among the HCWs and the general population of SARS-CoV-2 infections in Western Sicily and Italy; b. to describe the characteristics of HCWs infected with SARS-CoV-2 in the western Sicilian healthcare context during the first wave of the epidemic diffusion in Italy. Incidence and mean age of HCWs infected with SARS-CoV-2 were comparable in Western Sicily and in the whole Italian country. The 97.6% of infections occurred in HCWs operating in non-coronavirus disease 2019 (COVID-19) working environments, while an equal distribution of cases between hospital and primary care services context was documented. Nurses and healthcare assistants, followed by physicians, were the categories more frequently infected by SARS-CoV-2. The present study suggests that healthcare workers are easily infected compared to the general population but that often infection could equally occur in hospital and non-hospital settings. Safety of HCWs in counteracting the COVID-19 pandemic must be strengthened in hospital [adequate provision of personal protective equipment (PPE), optimization of human resources, implementation of closed and independent groups of HCWs, creation of traffic control building and dedicated areas in every healthcare context] and non-hospital settings (influenza vaccination, adequate psychophysical support, including refreshments during working shifts, adequate rest, and family support).

Analysis of appeals against the ruling of occupational physicians lodged with the Prevention and Occupational Epidemiology Operative Unit, ASP Palermo (Palermo Health Authority), from 2008-2010

INTRODUCTION

The responsibility of the Department for Prevention and Safety at the workplace of the Palermo Health Authority (ASP) is to monitor and coordinate the activity of occupational physicians operating in Palermo and its province. One of its obligations is to examine appeals "against the judgment of occupational physicians", "..and, after carrying out further investigation, confirm, modify or reverse the ruling itself" (art. 41, par. 6, legislative Decree 81/08).

OBJECTIVES

The purpose of this study was to analyze the appeals lodged against a judgment of fitness for work" submitted to the "Health Prevention and Occupational Epidemiology Operative Unit" of the Department of Prevention and Safety at the Workplace of the ASP Palermo, from 2008 to 2010.

METHODS

The total number of appeals lodged during the three-year period was 211, 174 of which were finalized.

RESULTS

The most frequent job category among the appellants was that of blue-collar workers, in various sectors, covering 44.5% of the subjects under study (93 cases). In 64.2% of the processed appeals (131 cases), the judgment of the physician was modified, while in the remaining 36.8% (73 cases) it was confirmed. The work fitness judgment with restrictions was the category against which most appeals were lodged, and the diseases in question mostly concerned the osteoarticular and cardiovascular systems.

CONCLUSION

In a context of continuous change in the labour field and the related risks to the health and safety of workers, the occupational physician must approach the worker in a comprehensive manner, through an assessment of the possible health problems and the working environment in which he/she operates.

[An analysis of appeals against the ruling of the occupational physician's lodged to the Department of Prevention and Safety in the Working Environment--Health Prevention and Occupational Epidemiology Operative Unit within the A.S.P. Palermo (Palermo Health Authority), years 2008-2010]

The purpose of this study is to analyze the appeals against a "suitability judgment for work" lodged to the U.O.S. "Health Prevention and Occupational Epidemiology Operative Unit" of Department of Prevention and Safety in the Working Environment within the ASP Palermo (U.O.S.), from 2008 to 2010. Studying the appeals gives an indirect view on the occupational physician activity and allows to monitor their actions, analysis aims at highlighting those issues around which any planning and implementation of coordination activities should be focused.

Prevalence of sensitization to Anisakis simplex among professionally exposed populations in Sicily

Anisakis simplex (AS) is a cause of allergic sensitization and potential occupational risk is suggested in fishermen and workers assigned to fish processing and sale. A cross-sectional study was conducted in order to assess possible health effects of occupational exposure to AS in workers recruited from western Sicily fisheries sector. Social, demographic, and occupation-related data were collected. Serum total immunoglobulin E (IgE) and specific IgE levels to AS (threshold >0.35 kU/L) were determined by an fluoroimmunoassay technique. Ninety-four subjects with potential occupational exposure (fishmongers, fishermen, fish industry employees) were recruited. Specific AS IgEs were detected in 20.2% of the study population. AS IgE seroprevalence was elevated 6.7-fold (p = .03) among fishermen/sailors compared with fish industry workers. The study suggested the importance to adopt specific prevention strategies against exposure to AS in the occupational setting.

[Occupational exposure to environmental pollution: observational study about a newspaper-agents group]

Environmental pollution constantly menaces urban people's health. This public-health question has a remarkable interest in occupational medicine, because some professions require operations outdoor for most of the day. Therefore airborne pollutants could be considered occupational risk factors. Our object is health evaluation of a newspaper-agents group of Palermo, in association with pollution level monitored during the 2006. We examined these subjects regarding especially lung, ear, kidney, liver and cardiovascular system, with particular consideration for endothelial structure.

RESULTS

high prevalence of carotid artery damage can't exclude a concausal role of airborne pollutants.

[Professional exposure to hardwood dusts in a group of Sicilian joiners]

Wood is a system of vegetable tissues chemically formed by biopolymers (90-99%) and phenolic substances, alkaloids, glucosides and saponins (1-10%). There are two botanical groups of wood: hardwood and softwood. Aim of present study was the research of possible work related diseases with professional exposure to hardwood about 25 joiners of Palermo in 2006; in fact wood dust inhalation is very dangerous for workers health because it is cancerogenous for nasal and paranasal sinus (1 IARC). We studied beech and fraxinus dusts (hardwood) and mahogany and teak dusts (exotic hardwood) in the environmental air of joiners during wood cutting and finishing touch. We also analysed exposed workers registry to know joiners duties, exposure values to wood dust, inhalatory exposure, wood type, chemical components, individual protection safety devices, environmental protection means. Then we examined workers medical case and risk histories. At the end we noticed that particle material in environmental air was regular according law reference values (D.Lgs. 66/2000: TLV-TWA 5 mg/m3); but although environmental dust values were normal, we found nasal haemorrhages in 3 workers and vasomotory headache in other 3; we also diagnosed one paranasal sinus polypus and then irritative contact dermatitis in 3 workers. So there is an answer: "can current TLV-TWA be protective and sure? And can it guarantee health of hardwood exposed workers?".

[Observational study on a group of health care workers assigned to antiblastic drugs manipulation in three Sicilian hospitals]

Neoplastic disease therapy problems, e.g. antiblastic drugs manipulation, is developing. We suggested correlation assessment between the lasting professional workers' exposition of three city hospital and disease development. We selected 43 exposed workers; we gave a questionnaire regarding the modality of activity; then we examined this sample with a protocol including clinical examination and special tests (blood tests, ECG, audiometry and spirometry).

RESULTS

over 55% of the workers reported aspecific complaint related to antiblastic exposure (headache, nausea, vertigo, dermatitis, alopecia, rhino-conjunctivitis, asthenia, parageusia, fauces dryness); we registered, instead, the absence of significant diseases related to antiblastic drugs exposure, because of both environmental and personal prevention, and clinical surveillance co-ordinated by occupational physician.

[The epidemiological trend of brucellosis in the provinces of Sicily]

The epidemiological trend of brucellosis in Italy has been uneven over the last few years since there was a decrease in incidence in some regions and an increase in others, including Sicily. The peak was reached in 1997 when 59% of the cases were reported in Sicily alone. Appropriate intervention strategies are therefore needed both as regards the general population and exposed workers in order to reduce the spread of this disease.

[Considerations on correct diagnosis of atypical electrocardiographic T-wave findings in young subjects]

An analysis is made of the significance of the occasional observation of asymptomatic T-wave changes (inversion). The authors maintain that only an overall evaluation of the anamnestic, clinical and laboratory findings will enable the physician to make a correct diagnosis and exclude from the start, via coordinated protocols, any silent ischaemic disease, and also a series of clinical conditions that the ECG can reveal as this disease. In this connection the authors report a clinical case that is deemed interesting due to the finding of ECG anomalies in an asymptomatic young, athletic subject observed during a periodical medical examination for the purpose of certifying fitness for a specific type of work.