Cardiovascular risk and the COVID-19 pandemic: A retrospective observational study in a population of healthcare professionals

BACKGROUND AND AIM

To contain the spread of COVID-19, many countries imposed several restrictive measures, leading to radical changes in daily life behaviors. Healthcare workers experienced additional stress due to the increased risk of contagion, possibly causing an increase in unhealthy habits. We investigated changes in cardiovascular (CV) risk assessed by the SCORE-2 in a healthy population of healthcare workers during the COVID-19 pandemic; an analysis by subgroups was also conducted (sportspeople vs sedentary subjects).

METHODS AND RESULTS

We compared medical examination and blood tests in a population of 264 workers aged over 40, performed yearly before (T0) and during the pandemic (T1, T2). We found a significant increase in the average CV risk, according to SCORE-2, during the follow-up in our healthy population, with a shift from a mean low-moderate risk profile at T0 (2.35%) to a mean high-risk profile at T2 (2.80%). Furthermore, in sedentary subjects was observed a greater and early increase in SCORE-2 compared to sportspeople.

CONCLUSIONS

Since 2019, we observed an increase in CV risk profile in a healthy population of healthcare workers, particularly in sedentary subjects, highlighting the need to reassess SCORE-2 every year to promptly treat high-risk subjects, according to the latest Guidelines.

Age-Related Dynamics of Serum Anti-Spike IgG Ab After the Third Dose of BNT162b2 Vaccine in a Naive Health Care Workers Population

The kinetics of postvaccination serum anti-Spike IgG concentration were determined in 1,541 health care workers (Sant'Andrea Hospital of Rome, Italy) with no prior infection by SARS-COV-2. Anti-Spike IgG were measured at 3, 12, and 24 weeks after the completion of the primary vaccine cycle (two doses of the BNT162b2 vaccine by Biontech/Pfizer) and 3 weeks apart a third BNT162b2 dose. Stratification of the study population by age (decades from 21-30 to 61-70) highlighted that 24 weeks after cycle completion all age groups had an order of magnitude reduction in serum IgG titers. Considering older adults (age 61-70), they had significantly lower serum IgG titers at each time point compared with younger people, except after the booster dose, which induced similar and elevated IgG titers despite the age.

Prevalence of Sars-Cov-2 Infection in Health Workers (HWs) and Diagnostic Test Performance: The Experience of a Teaching Hospital in Central Italy

(1) Background: Health workers (HWs) are at high risk of acquiring SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infections. Therefore, health authorities further recommend screening strategies for SARS-CoV-2 infection in exposed or high-risk HWs. Nevertheless, to date, the best/optimal method to screen HWs for SARS-CoV-2 infection is still under debate, and data on the prevalence of SARS-CoV-2 infection in HWs are still scarce. The present study aims to assess the SARS-CoV-2 infection rate amongst HWs in a teaching hospital in Central Italy and the diagnostic performance of SARS-CoV-2 serology (index test) in comparison with the SARS-CoV-2 RNA PCR assay (reference standard). (2) Methods: A cross-sectional study on the retrospective data of HWs tested for SARS-CoV-2 by RNA-RT-PCR on nasopharyngeal swabs and by an IgM/IgG serology assay on venous blood samples, irrespective of exposure and/or symptoms, was carried out. (3) Results: A total of 2057 HWs (median age 46, 19-69 years, females 60.2%) were assessed by the RNA RT-PCR assay and 58 (2.7%) tested positive for SARS-CoV-2 infection. Compared with negative HWs, SARS-CoV-2-positives were younger (mean age 41.7 versus 45.2, p < 0.01; 50% versus 31% under or equal to 40 years old, p < 0.002) and had a shorter duration of employment (64 versus 125 months, p = 0.02). Exposure to SARS-CoV-2 was more frequent in positive HWs than in negatives (55.2% versus 27.5%, p < 0.0001). In 44.8% of positive HWs, no exposure was traced. None of the positive HWs had a fatal outcome, none of them had acute respiratory distress syndrome, and only one required hospitalization for mild/moderate pneumonia. In 1084 (51.2%) HWs, nasopharyngeal swabs and an IgM/IgG serology assay were performed. With regard to IgM serology, sensitivity was 0% at a specificity of 98.99% (positive predictive value, PPV 0%, negative predictive value, NPV 99.2%). Concerning IgG serology and irrespective of the time interval between nasopharyngeal swab and serology, sensitivity was 50% at a specificity of 99.1% (PPV 28.6%, NPV 99.6%). IgG serology showed a higher diagnostic performance when performed at least two weeks after testing SARS-CoV-2-positive at the RNA RT-PCR assay by a nasopharyngeal swab. (4) Conclusions: Our experience in Central Italy demonstrated a low prevalence of SARS-CoV-2 infection amongst HWs, but higher than in the general population. Nearly half of the positive HWs reported no previous exposure to SARS-CoV-2-infected subjects and were diagnosed thanks to the proactive screening strategy implemented. IgG serology seems useful when performed at least two weeks after an RNA RT-PCR assay. IgM serology does not seem to be a useful test for the diagnosis of active SARS-CoV-2 infection. High awareness of SARS-CoV-2 infection is mandatory for all people, but especially for HWs, irrespective of symptoms, to safeguard their health and that of patients.

Reverdin-Isham osteotomy versus Endolog system for correction of moderate hallux valgus deformity: a Randomized Controlled Trial

OBJECTIVES

Several procedures have been described for the management of hallux valgus deformity. In this paper we would like to compare our experiences with two techniques (Endolog system and Reverdin-Isham osteotomy) with a randomized study. To our knowledge, this is the first study to be reported in the literature, that provides a detailed comparison of these two techniques to treat moderate hallux valgus.

MATERIALS AND METHODS

A total of 40 consecutive patients (40 feet) with moderate symptomatic hallux valgus were randomly assigned into two groups, to compare the results of Reverdin-Isham osteotomy (group A,20 feet) and Endolog system (group B, 20 feet).

RESULTS

The average follow-up was of 23.7 ±7.7months . The average correction of HVA and IMA achieved in group A was 17.1° ±6.2° and 5.2° ±2.6° respectively, while in group B, it was 14°±6.2° and 7.7°±2.6° respectively. The mean AOFAS score improved from a pre-operative of 40.5 ±15.5 points to 90.3 ±5.3 points in group A, and from 32.4 ±16.8 points to 89.2 ±10.5 in group B.

CONCLUSIONS

No statistically significant differences were detected between the two groups with respect to the AOFAS score, HVA, and IMA. Both groups showed good to excellent results.

[DIFFERENT APPROACHES FOR CHEMICAL RISK ASSESSMENT IN LABORATORIES]

The aim of this study was to compare the different approaches used for chemical risk assessment, in relation to the perception of riskfor operators, in some research laboratories of a hospital in Rome. All information regarding the chemicals used for the application of three algorithmic models for chemical risk assessment ("Movarisch", "Inforisk", "Archimede") were collected. An environmental and biological monitoring and a study on the combined exposure to multiple chemicals using the World Health Organization proposed steps were carried out. A questionnaire was prepared for the identification of risk perception. An estimation of chemical risk with algorithms was compared with data from monitoring: findings showed that estimated risk was higher than those identified with airborne or urine concentrations, always under their limit values. The study of multiple exposure showed a possible cumulative risk, in some cases, but the conditions of use (volume and time) often bring to a reduced one. The perception of risk attributed to the monitored hazardous substances showed a correct perception in all laboratories and for all workers, with regard to the substances manipulated.

[The organization and management of First Aid in the workplace: critical issues and innovations to be introduced]

Develop an effective First Aid's system in workplaces is significantly important to the outcomes of accidents at work, thus contributing positively to create healthy and safe environments, improving responsible attitude and risk perception by workers. The italian regulation (D. Lgs. 81/08; DM 388/03) gives an important role to First Aid within the system for managing health and safety in workplaces and requires the employers to designate and train workers and organize facilities in the workplace. However, to ensure that First Aid's system actually contributes to increasing health and safety in workplaces, it's necessary to verify its effectiveness, beyond the law compliance. The article stands to evaluate the critical issues and related innovations to be introduced in this context, by analyzing data from literature and field experiences involving actors in the prevention system. The goal is to provide suggestions and action proposals to improve first aid's system in workplaces, paying particular attention to the aiders training (selection, motivation, teaching methods, retraining), as well as introduce to innovations to allow an immediate and timely emergency response (company equipments, other useful devices). On this last aspect, it has given particular emphasis to the introduction of semi-automatic defibrillator (AED), which is essential in case of sudden cardiac arrest with ventricular fibrillation, and special aiders training by means of BLSD (Basic Life Support and Defibrillation) courses based on international guidelines.

[Agricultural work: noise exposure and cardiovascular effects]

Aim of the study was to assess cardiovascular effects in the farmers exposed to noise. We assessed two samples of 143 farmers using tactor (mean age 51.0 +/- 10.5 years, length of service 33.0 +/- 10.5 years) and 193 farmers not exposed to noise (controls) (mean age 48.3 +/- 13.7 years, length of service 30.6 +/- 14.7 years). After the phonometric measurements all farmers were undergone to a medical examination, measurements of blood pressure, a audiometric test and a electrocardiogram. The collected data show an increased prevalence of hypertension and electrocardiographic anomalies in farmers exposed to noise (systolic hypertension n. 53, 37.1%; diastolic hypertension n. 60, 42.0%; electrocardiographic anomalies n. 44; 30.8%) compared to the control group (systolic hypertension n. 23, 16.1%; diastolic hypertension n. 26, 18.2%; electrocardiographic anomalies n. 5; 3.5%) (systolic hypertension p = 0.002; diastolic hypertension p = 0.003; electrocardiographic anomalies p = 0.030). Our results could be taken to mean that there are effects of chronic exposure to noise on cardiovascular apparatus; this would stimulate the screening programmes for farmers.

The effects of air pollution on the lipid balance of traffic police personnel

BACKGROUND

The purpose of our study was to evaluate the effects of urban pollution on the lipid balance of members of a municipal police force in a big city.

SUBJECTS AND METHODS

Our case-control study comprised 118 male members of the police force performing traffic duties, and 118 blood donors who perform office work, and was paired by age and length of service. Total cholesterol, HDL and triglycerides were studied.

RESULTS

The comparison of the average values of HDL cholesterol and triglycerides between the exposed traffic police group and the control group showed significant differences. The difference in the frequency distributions of HDL cholesterol and triglycerides between the exposed group and control group was significant as well. The results suggest the possibility of an alteration in the lipid balance among asymptomatic people who are exposed to air pollution.

CONCLUSION

The results suggest that some chemical agents (such as carbon dioxide) contained in the urban pollution of a big city could cause dyslipidemia among people exposed to such air pollution.

Metabolic polymorphisms and urinary biomarkers in subjects with low benzene exposure

The effect of some common metabolic polymorphisms on the rate of trans,trans-muconic acid (TMA) and S-phenylmercapturic acid (SPMA) excretion was investigated in 169 policemen exposed to low benzene levels (<10 microg/m3) during the work shift. End-shift urinary concentrations of TMA and SPMA, normalized to unmetabolized blood benzene concentration, were used as indicators of individual metabolic capacity. CYP2E1, NQO1, GSTM1, and CSTT1 polymorphisms were analyzed in all subjects by polymerase chain reaction (PCR) restriction fragment length (RFL). The results obtained show significantly elevated levels of TMA and SPMA in urine of smokers compared to nonsmokers, whereas no correlation with environmental benzene was observed. TMA/blood benzene ratio was partially modulated by glutathione S-transferase (GST) genotypes, with significantly higher values in null individuals (GSTM1 and GSTT1 combined). However, a greater fraction of total variance of TMA/blood benzene in the study population was explained by other independent variables, that is, season of sampling, smoking habits, and gender. Variance in SPMA/blood benzene ratio was only associated with smoking and occupation, whereas no significant role was observed for the metabolic polymorphisms considered. These results suggest that in a population exposed to very low benzene concentrations, urinary TMA and SPMA levels are affected to a limited extent by metabolic polymorphisms, whereas other factors, such as gender, lifestyle, or other confounders, may account for a larger fraction of the interindividual variability of these biomarkers.

Latex allergy. History, diagnosis and prevention

During the past 10 years the incidence of natural rubber latex (NRL) allergy has dramatically increased. It occurs predominantly in certain high risk group: health care workers, latex industry workers, immune compromised individuals (such as children with spina bifida) and persons with positive risk factors (such as multiple surgeries). The epidemiology, history, mechanism, clinical symptoms and signs, and diagnosis of latex allergy are presented briefly. The subject of this review is to understand the importance in reducing the prevalence of latex allergy: reducing exposure, using appropriate work practices, training and educating workers, monitoring symptoms and substituting non latex products when appropriate.

Physiopathology of the renin-angiotensin system in the ovary

The present review confirms the existence of the so-called "ovarian-derived prorenin-angiotensin cascade". It also describes the physiopathology of the system and, consequently, its role in the genesis of phenomena concerning reproductive function such as ovulation, steroid synthesis and folliculogenesis. Moreover, the "ovarian-derived prorenin-angiotensin cascade" appears to play an important role in the aetiopathogenesis of diseases such as ovarian tumours, ovarian hyperstimulation syndrome and ectopic pregnancy.

[Gastrin and gastrointestinal neoplasias]

In this paper the authors focus attention on the role of gastrin as a carcinogenic factor. The aim was to bring together the numerous controversial studies on this subject, adding the authors' own personal clinical experience. Gastrin (G) is responsible for the development of carcinoids, as has been experimentally shown in Mastomys rats, and more recently in man. This hormone is regarded as a mitogen for cells in the gastroenteric tract; it acts through specific reactors and messengers, including AMPc and protein kinase A (PKA). Its role in the development of other neoplasias of the gastroenteric tract appears to be linked, but not always subordinate, to the presence of growth factors such as: EGF and TGF-alpha, and also to the possible stimulation of oncogens induced by hypergastrinemia.

Physiopathology of the renin-angiotensin system in the ovary

The present review confirms the existence of the so-called "ovarian-derived prorenin-angiotensin cascade". It also describes the physiopathology of the system and, consequently, its role in the genesis of phenomena concerning reproductive function such as ovulation, steroid synthesis and folliculogenesis. Moreover, the "ovarian-derived prorenin-angiotensin cascade" appears to play an important role in the aetiopathogenesis of diseases such as ovarian tumours, ovarian hyperstimulation syndrome and ectopic pregnancy.

Effects of Panax Ginseng C.A. Meyer saponins on male fertility

Sixty-six patients have been treated with Panax Ginseng C.A. Meyer extract, of whom 30 oligoastenospermic sine causa (group A), 16 oligoastenospermic with idiopathic varicocele (group B). Twenty age-matched volunteers were used as controls (group C). Use of Panax Ginseng extract showed an increase in spermatozoa number/ml and progressive oscillating motility, an increase in plasma total and free testosterone, DHT, FSH and LH levels, but a decrease in mean PRL. It is suggested that ginsenosides may have an effect at different levels of the hypothalamus-pituitary-testis axis.

Relationship between autoimmune thyroid disease Rand Alzheimer's disease

Alzheimer's Disease (AD) is a particular form of degenerative dementia probably due to deposit in the brain cortex of a non soluble protein called beta-A4 amyloid in senile plaque form. beta A4 is an aberrant mutant proteolytic product of Amyloid Protein Precursor (APP) codified on chromosome 21. Trisomy 21 is responsible for Down's Syndrome (DS). Down's patients have been shown to develop a form of Alzheimer's after 50 years of age, and high blood levels of antithyroid antibodies are also present in a significant percentage of these cases. In the present investigation, antithyroid antibody titres have been studied by means of RIA in group of 34 AD patients. As compared to 30 non-demented controls, AD subjects showed a significant increase in the mean values of antithyroglobulin (TgAb) and antimicrosomial (MCSAb) autoantibodies. The physiopathological relationship regarding this association is discussed.