Tuberculosis contact investigations in congregate settings in Rome, Italy: contribution of migration

Background

In middle to low incidence countries tuberculosis (TB) is known to concentrate in big cities as national incidence falls: in the last decade TB incidence in Rome metropolitan area and in Lazio region has been higher than the national estimates; TB incidence among foreign born fell by more than half despite remaining higher than among Italian born.

We aimed to describe the current dynamics of TB transmission among residents of our local health unit in Rome metropolitan area in order to drive specific TB control interventions at local level.

Methods

We retrospectively evaluated characteristics of TB cases and results of contact investigations among the residents of ASL Roma 2 in congregate settings over year 2018.

Results

Overall 217 TB cases were notified, of which 70.5% with pulmonary involvement. Male/female ratio was 2.4/1 and age group most affected was 25-44 among foreign born and >65 among natives. During the study period foreign born cases accounted for 65% of the total number of TB cases. 19/141 (13.5%) foreign born patients were hosted in a reception center. 479 exposed close contacts were screened, with no evidence of secondary TB disease transmission. No identifiable links were found among cases occurred in the same immigrant reception center.

Conclusions

Italian guidelines recommend symptom screening for TB and LTBI testing both of new entrants and of long term residents -including second–generation migrants- from high TB burden countries. These findings suggest that local public health efforts should prioritize the identification of reactivations of remotely acquired latent TB rather than of new postarrival infections acquired in the host county through local transmission.

Key messages

City-specific data on TB incidence trends among native and foreign-born residents help understanding the wider interaction between migration and TB. To prevent TB incidents in congregate settings remotely acquired latent TB should be targeted.

Update of the mortality study of workers exposed to polychlorinated biphenyls (Pcbs) in two Italian capacitor manufacturing plants

BACKGROUND

PCB carcinogenicity to humans is still controversial. Cohort mortality studies in PCB-exposed workers reported elevated risks for the following causes of death: liver, stomach, digestive, brain, prostate cancers and non-Hodgkin lymphoma.

OBJECTIVES

The purpose of this study was to update as of December 2006 the mortality experience of two Italian cohorts of workers employed in the manufacture of capacitors impregnated with PCBs.

METHODS

Age-gender-and calendar period adjusted Standardized Mortality Ratios (SMRs) and 95% Confidence Intervals (CI) were calculated using regional rates. Analyses by duration of employment and time since first employment were performed Results: Vital status was ascertained for 98.9% of the study subjects. Mortality from biliary tract cancer among males (SMR 3.91; 95%CI 1.47-10.41), digestive cancer "not otherwise specified" in the whole cohort (SMR 2.54; 95%CI 1.21-5.34), and brain cancer in Plant I (SMR 2.13; 95%CI 1.02-4.48), were significantly increased. Increased risks were also observed for Hodgkin's and non-Hodgkin lymphoma. No linear associations between mortality and duration of employment or latency were observed for these cancers. Mortality from stomach cancer did not differ from expectation in the whole cohort, however an increasing risk with increasing duration of employment was detected (p for trend=0.02).

CONCLUSIONS

The current update suggests possibly increased cancer risks in PCB-exposed workers, affecting in particular the digestive system, brain, and lymphohemopoietic tissue. However the limited sample size, the lack of clear trends with duration of employment or with latency period, preclude to derive definite conclusions about PCB exposure and the increased cancer risks.

Impact of ambient air pollution on birth outcomes: systematic review of the current evidences

BACKGROUND

There is growing interest in the possible association between maternal exposure to air pollutants and reproductive outcomes, particularly birth weight and gestational duration. Four systematic reviews of data were published in 2004-2005, but the wide variability of methods and results among the different studies produced conflicting conclusions. This study was done to establish whether recent literature has provided more conclusive evidence regarding a link between air pollutants and birth outcomes.

METHODS

We reviewed 18 original epidemiological studies on maternal exposure to particulate matter (PM), NO2, CO and O3, and outcomes of preterm delivery or low birth weight published since 2004.

RESULTS

Large variability across studies in design, precision in maternal georeferentiation, methods in exposure assessment, and type of pollutant considered, limited the strength of the evidence of adverse affects of ambient air pollution on birth outcomes. Nevertheless, evidence suggests exposure to particulate matter, especially at its finest fraction (PM25), may have the potential to adversely affect birth weight. We further found limited evidence of a possible association between maternal exposure to air pollutants during the first trimester and increased risk of preterm delivery.

DISCUSSION

The observed adverse effects were generally small. However, possible important factors such as maternal activity pattern, diet, smoking and occupation, that are usually not reported on the birth certificate, might have led to exposure misclassification and confounding and could have hidden moderately increased risks. In conclusion, additional studies since 2004 have not been able to conclusively show a definitive correlation between air pollution and adverse birth outcomes; although it appears that small size particulate matter could affect birth weight. Additional well-conducted studies that include detailed information on maternal risk factors and using validated models for estimating maternal exposure are needed to establish the extent of the association between air pollution and birth outcomes.

Effects of exposure to air pollution on blood coagulation

BACKGROUND

Consistent evidence has indicated that air pollution increases the risk of cardiovascular diseases. The underlying mechanisms linking air pollutants to increased cardiovascular risk are unclear.

OBJECTIVES

We investigated the association between the pollution levels and changes in such global coagulation tests as the prothrombin time (PT) and the activated partial thromboplastin time (APTT) in 1218 normal subjects from the Lombardia Region, Italy. Plasma fibrinogen and naturally occurring anticoagulant proteins were also evaluated.

METHODS

Hourly concentrations of particulate (PM10) and gaseous pollutants (CO, NO2, SO2, and O3) were obtained from 53 monitoring sites covering the study area. Generalized additive models were applied to compute standardized regression coefficients controlled for age, gender, body mass index, smoking, alcohol, hormone use, temperature, day of the year, and long-term trends.

RESULTS

The PT became shorter with higher ambient air concentrations at the time of the study of PM10 (coefficient = -0.06; P < 0.05), CO (coefficient = -0.11; P < 0.001) and NO2 (coefficient =-0.06; P < 0.05). In the 30 days before blood sampling, the PT was also negatively associated with the average PM(10) (coefficient = -0.08; P < 0.05) and NO2 (coefficient = -0.08; P < 0.05). No association was found between the APTT and air pollutant levels. In addition, no consistent relations with air pollution were found for fibrinogen, antithrombin, protein C and protein S.

CONCLUSIONS

This investigation shows that air pollution is associated with changes in the global coagulation function, suggesting a tendency towards hypercoagulability after short-term exposure to air pollution. Whether these changes contribute to trigger cardiovascular events remains to be established.

Effects of exposure to air pollution on blood coagulation

BACKGROUND

Consistent evidence has indicated that air pollution increases the risk of cardiovascular diseases. The underlying mechanisms linking air pollutants to increased cardiovascular risk are unclear.

OBJECTIVES

We investigated the association between the pollution levels and changes in such global coagulation tests as the prothrombin time (PT) and the activated partial thromboplastin time (APTT) in 1218 normal subjects from the Lombardia Region, Italy. Plasma fibrinogen and naturally occurring anticoagulant proteins were also evaluated.

METHODS

Hourly concentrations of particulate (PM10) and gaseous pollutants (CO, NO2, SO2, and O3) were obtained from 53 monitoring sites covering the study area. Generalized additive models were applied to compute standardized regression coefficients controlled for age, gender, body mass index, smoking, alcohol, hormone use, temperature, day of the year, and long-term trends.

RESULTS

The PT became shorter with higher ambient air concentrations at the time of the study of PM10 (coefficient = -0.06; P < 0.05), CO (coefficient = -0.11; P < 0.001) and NO2 (coefficient =-0.06; P < 0.05). In the 30 days before blood sampling, the PT was also negatively associated with the average PM(10) (coefficient = -0.08; P < 0.05) and NO2 (coefficient = -0.08; P < 0.05). No association was found between the APTT and air pollutant levels. In addition, no consistent relations with air pollution were found for fibrinogen, antithrombin, protein C and protein S.

CONCLUSIONS

This investigation shows that air pollution is associated with changes in the global coagulation function, suggesting a tendency towards hypercoagulability after short-term exposure to air pollution. Whether these changes contribute to trigger cardiovascular events remains to be established.

Polymorphisms in Th1-type cell-mediated response genes and risk of gastric cancer

Helicobacter pylori infection, the dominant risk factor for gastric cancers, has been shown to elicit T helper type 1 (Th1) polarized immunological responses. We conducted a population-based study of 305 gastric cancer cases and 427 age- and gender-matched controls in Warsaw, Poland, to evaluate the association with several variants in genes responsible for Th1-cell-mediated response. Genotyping was performed on genomic DNA by TaqMan(TM) assays to determine TNFA (-308 G>A, -417 G>A, -555 G>A, -1036 C>T, -1042 C>A, -1210 T>C), IL1A (-889 C>T), IFNGR2 (Ex7-128 T>C, Ex2-34 C>G and Ex2-16 A>G) and IL12A (IVS2-798 T>A, IVS2-701 C>A and Ex7+277 G>A) polymorphisms. We used unconditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for sex, age, education and smoking status. Out of six single nucleotide polymorphisms (SNPs) tested in TNFA, gastric cancer risk was significantly associated with the TNFA (-308 G>A) polymorphism, with ORs of 1.4 (95% CI: 1.0-2.0) for the G/A and 2.5 (95% CI: 1.3-4.9) for the A/A genotype carriers, when compared with the more frequent genotype (G/G) (P-trend < 0.001). Among the three tested SNPs in the IFNGR2 gene, only the Ex7-128C>T polymorphism was associated with increased risk, with ORs of 1.5 (95% CI: 1.0-2.3) for T/C and 1.7 (95% CI: 1.1-2.7) for C/C carriers when compared with T/T carriers (P-trend = 0.01). Subjects carrying both IFNGR2 Ex7-128 C/C and TNFA -308 A/A genotypes had the highest risk (OR = 5.5, 95% CI: 1.5-19.4), although the interaction was not statistically significant. IL1A (-889 C>T) and the three examined IL12A variants were unrelated to gastric cancer risk. Our findings suggest that two Th1-related polymorphisms (TNFA -308 A>G and IFNGR2 Ex7-128 C>T) may increase the risk of gastric cancer.

Accident vasculaire cérébral hémorragique : nouveautés sur la prise en charge

Haemorrhagic stroke is frequent and associated with a high mortality and morbidity. Less than 30% of patients are still alive five years after onset and few patients regain functional independence. The worsening effect of anticoagulation has been demonstrated and the failure to rapidly normalize coagulation further increases haematoma expansion. In a recent phase II trial, recombinant activated factor VII given within 4 hours of stroke onset, reduced haematoma growth, mortality and disability. An aggressive blood pressure and intracranial pressure control early after the haemorrhage seems beneficial. A large prospective randomized study (the STICH trial) did not demonstrate any beneficial effect of surgery.

Arrhythmogenic right ventricular cardiomyopathy: clinicopathologic correlation based on a revised definition of pathologic patterns

Different morphologic features of arrhythmogenic right ventricular cardiomyopathy (ARVC) have been described. However, it is still unclear whether they correspond to distinct forms of the same disease. A pathologic study was performed on a series of ARVC (15 from heart transplant and 12 from autopsy) from 2 Italian referral university hospitals. Based on both myocellular features and the nature of myocardial replacement, hearts were divided into 2 groups: infiltrative, with a lacelike pattern of transmural fatty infiltration and strands of normal residual cardiomyocytes (n = 11); and cardiomyopathic, with massive myocardial replacement by fibro fatty tissue and cardiomyopathic changes (such as hypertrophy and myofibril loss) of residual cardiomyocytes (n = 16). Hearts from the infiltrative group were mostly obtained at autopsy of patients who died suddenly. Fatty substitution was limited almost exclusively to the right ventricle. Mitral valve dysplasia (prolapse or cleft) was frequently present. Hearts from the cardiomyopathic group came mainly from heart transplants for congestive heart failure. Fibro fatty replacement was more extensive, usually biventricular. Active myocarditis and features suggestive of myocardial transdifferentiation were also observed. Despite these differences in clinical outcome and morphologic features, patients from the 2 groups showed similar mean age, sex distribution, occurrence of threatening ventricular arrhythmias, and prevalence of family history of sudden death, arrhythmias, or cardiomyopathy. Infiltrative and cardiomyopathic patterns represent different clinical and pathologic subsets of ARVC. Myocellular features are an important clue in the distinction between the two entities. The differentiation between the 2 patterns is feasible on endomyocardial biopsy and could give important prognostic information.

Eosinophilic infiltration immediately following transplantation: recurrent hypersensitivity reaction?

Hypersensitivity myocarditis is a well-known complication of pharmaceutical therapy, often requiring heart transplantation. We report the unusual case of pre-transplant hypersensitivity myocarditis with eosinophilic myocardial infiltration in the donor heart, demonstrated by needle biopsy at the time of transplant ('time-zero' biopsy). At first the myocarditic process was temptatively attributed to a pre-transplant pathology in the donor heart, but the close similarity between the pre-transplant and the post-transplant infiltrate and the clinical data of an eosinophilic peak of the recipient during the transplant procedure brought to the diagnosis of early recurrent hypersensitivity myocarditis.

DNA damage in stomach, kidney, liver and lung of rats treated with atrazine

The genotoxic activity of atrazine, a widely used triazine herbicide, was assayed by the DNA alkaline elution technique in rats given orally a single high dose or repeated daily doses. DNA breaks (and/or alkali-labile lesions) were detected in cell suspensions obtained from stomach, kidney and liver, but not in those from lung.

Occlusion of the carotid artery: prognosis (natural history) and the possibilities of surgical revascularization

A retrospective study was made of a group of 44 patients with arteriosclerotic occlusion of the internal carotid artery trying to identify a group that might benefit from extracranial-intracranial arterial bypass. Eight of the 44 patients died of cerebral infarction. Seven of these deaths were due to the cerebral infarction that prompted the arteriogram and the only fatal infarct during the period of follow-up occurred in the opposite cerebral hemisphere. Four nonfatal strokes occurred during the follow-up period, and these also were in the cerebral hemisphere contralateral to the carotid occlusion. We conclude that the role of extracranial-intracranial arterial bypass is limited to the occasional patient who has recurrent symptoms due to vascular insufficiency in the cerebral hemisphere distal to an occluded carotid or middle cerebral artery. The main role of surgery appears to lie in the opening of the occluded carotid artery in selected patients with acute stroke and in the prophylactic repair of contralateral carotid stenosis.