The antithrombin activity of unfractionated heparin (UFH) is offset by extracellular histones, which, along with DNA, represent a novel mediator of thrombosis and a structural component of thrombi. ...Here, we systematically evaluated the effect of histones, DNA, and histone-DNA complexes on the anticoagulant and profibrinolytic activities of UFH, its derivatives enoxaparin and fondaparinux, and the direct thrombin inhibitor dabigatran. Thrombin generation was assessed by calibrated automated thrombinography, inhibition of factor Xa and thrombin by synthetic substrates, tissue plasminogen activator-mediated clot lysis by turbidimetry, and thrombin-activatable fibrinolysis inhibitor (TAFI) activation by a functional assay. Histones alone delayed coagulation and slightly stimulated fibrinolysis. The anticoagulant activity of UFH and enoxaparin was markedly inhibited by histones, whereas that of fondaparinux was enhanced. Histones neutralized both the anti-Xa and anti-IIa activities of UFH and preferentially blocked the anti-IIa activity of enoxaparin. The anti-Xa activity of fondaparinux was not influenced by histones when analyzed by chromogenic substrates, but was potentiated in a plasma prothrombinase assay. Histones inhibited the profibrinolytic activity of UFH and enoxaparin and enhanced that of fondaparinux by acting on the modulation of TAFI activation by anticoagulants. Histone H1 was mainly responsible for these effects. Histone-DNA complexes, as well as intact neutrophil extracellular traps, impaired the activities of UFH, enoxaparin, and fondaparinux. Dabigatran was not noticeably affected by histones and/or DNA, whatever the assay performed. In conclusion, histones and DNA present in the forming clot may variably influence the antithrombotic activities of anticoagulants, suggesting a potential therapeutic advantage of dabigatran and fondaparinux over heparins.
The contamination of shellfish with gastroenteric viruses may cause outbreaks because they are often eaten raw or under-cooked. High-hydrostatic pressure treatments have already proven to be ...effective in reducing high viral load in shellfish samples. The objectives are the assessment of the viral load reduction of contaminated clams using HHP treatments at different pressures and times and the study of the changes caused by these treatments in some food physical parameters.
Clams were contaminated with a solution containing Feline Calicivirus; they were closed in envelopes and treated with 300, 400, 500, 600 MPa for 1, 3, 5, 7 min for every pressure value. After the treatment the residual viral titre was calculated. The texture parameters were obtained after treating clams samples at the same pressure values but only for 3 and 7 min and analysing them with a TPA test.
HHP treatments of 500 and 600 MPa were sufficient to cause a total inactivation at every timelength considered while with 300 and 400 MPa after 1 min, concentrations of 1.13 and 0.55 respectively were found. In general hardness and gumminess tend to increase after the treatment whereas springiness and cohesiveness decrease a bit.
HHP treatments showed good sterilization ability against FCV but it's necessary to consider that FCV has a lower resistance to disinfection than Human norovirus. Texture changes are in line with what is reported in literature.
Abstract
Introduction
Legionnaire’s diseases (LD) is a significant cause of community-acquired pneumonia. An increasing number of cases has been linked with occupational exposures. The aim of this ...study was understanding knowledge, attitudes and practices of occupational physicians (OPh) towards LD.
Methods
A questionnaire-based cross-sectional study (April 2019), collecting a convenience sample of OPh operating in the Parma Province. Knowledge status (KS), Risk Perception (RP), and actual participation to the LD risk assessment were assessed. Multivariate odds ratios (mOR) for factors associated with participation to the LD risk assessment were calculated by means of a binary logistic regression analysis.
Results
80 OPh participated to the survey (76.9% participation rate; mean age 48.2±11.2 years): even though the majority of them assisted at least one enterprise at potentially high risk for LD (i.e. 41.4% retirement houses, 27.1% water treatment plants including spas and pools, 25.7% hospitals) only 42.9% had participated to the LD risk assessment. The majority of OPh did not acknowledge diabetes (52.9%), cancer (65.7%), alcoholism (77.1%) as risk factors for LD, while a large share of OPh did not recognize hospital (50.0%), retirement houses (48.6%), swimming pools (48.6%) and spas (35.7%) as high risk environments. Moreover, participants underestimated both actual frequency (>1000 cases/year) and severity (lethality 10-15%) of LD in Italy, and occupational RP was not coincidentally low (43.2%±20.3). Participants reporting better KS were more likely to participate to the risk assessment (mOR 4.82 95%CI 1.06-21.94), while RP was eventually unrelated with preventive practices.
Conclusions
OPhs were diffusely affected by significant knowledge gaps on the actual risk factors for LD. Their misperceptions have the potential to negatively influence daily practice, impairing prevention of LD on the workplaces, and should be specifically targeted by information campaigns.
Key messages
Occupational Physicians were affected by significant knowledge gaps, particularly on individual and occupational risk factors for legionnaire disease.
In order to better address the increasing threat of Legionnaire Disease, Occupational Physicians should be specifically targeted by information campaings.
Abstract
Introduction
First Responders (FR) are front-line healthcare workers potentially exposed to different infectious agents. Characterizing their knowledge, attitudes and practices (KAP) towards ...immunizations has therefore the potential to significantly improve occupational health and safety.
Methods
A questionnaire-based cross-sectional study was performed during October 2018, collecting a convenience sample among FR from the Parma Province. Participants were inquired on 3 recommended vaccinations (i.e. seasonal influenza vaccine, SIV; measles vaccine, MeV; pertussis vaccine, Pa) and for meningococcal vaccines (MEN, not officially recommended in FR). Knowledge status (KS) and Risk Perception (RP) were assessed as percent values. Multivariate odds ratios (mOR) for factors associated with vaccination status were calculated by means of a binary logistic regression analysis.
Results
A total of 161 questionnaires were retrieved (mean age 45.1±14.1 years; seniority 10.8 ± 8.6 years). Internal consistency was good (Cronbach’s alpha = 0.894). KS was unsatisfying (46.5% ± 32.4) with uncertainties on the recommendations for MeV and MEN (39.1% and 34.2% incorrect answers). The majority of respondents were favorable towards MEN (89.4%), MeV (87.5%), Pa (83.0%), while 55.3% exhibited a favorable attitude for SIV, and 28.0% had received SIV 2018 (self-reported lifetime status for MEN 26.1%, MeV 42.2%, Pa 34.8%). RP was unsatisfying, particularly for SIV (33.9% ± 18.4). Interestingly enough, neither KS nor RP were associated with vaccination rates, being the main predictor for SIV 2018 a seniority ≥ 10 years (mOR 3.26, 95%CI 1.35-7.91), and higher educational achievements for both Pa (mOR 3.27, 95%CI 1.29-8.30) and MeV (mOR 2.69, 95%CI 1.09-6.65).
Conclusions
Reasons for vaccination gaps in FR apparently do not find their roots only in FRs’ incomplete KS or RP. However, the very low vaccination rates for SIV, MeV and Pa recommends stronger and more appropriate information campaigns.
Key messages
Main drivers of vaccination status in First Responders are not solely their knowledge status or risk perception.
Achieving better vaccination rates in First Responders requires the understanding of a complex interplay of individual factors.
The human enteroviruses (EV) are the most common and widespread human viruses in the world. They have bowel as their natural habitat and they can spread in the environment through the faecal ...excretion. In the continental climate Regions these viruses may cause epidemic outbreaks in summer and fall, while in the tropical Regions the EV infections present a high incidence during all year. The symptoms can be minor or subclinic, but they can be also associated to rare and serious diseases. The aim of this study was to evaluate the environmental circulation of polioviruses and non-polio enteroviruses (NPEV) using standard methods of urban wastewater surveillance recommended by the WHO.
A total of 188 wastewater samples were collected between February 2005 and December 2008 from two sewage treatment plants in Parma. The sampling was carried out twice a month. Environmental variables were collected for each day of sampling.
Out of the 188 examined wastewater samples, 78.7% were positive to the enterovirus research. One out of the 148 positive samples was identified as poliovirus Sabin-like type 3. The remaining 147 positive samples were enteroviruses non polio: Coxsakieviruses and Echoviruses. All Coxsakieviruses isolated were of type B.
The proposed method has shown high sensibility, also in presence of very low expected prevalence of vaccine poliovirus. It allows to verify the kind and relative frequency of enteric viruses circulating in the country, whose characteristics (virulence and pathogenicity) may vary with reference to a different epidemiologic and demographic structure of the resident population.
Abstract
Problem
Acute flaccid paralysis (AFP) active surveillance is the gold standard in polio eradication process. Italy was classified in 2017 at intermediate risk of poliovirus reintroduction ...based on suboptimal poliovirus surveillance. The aim of this study was to restore an adequate level of AFP surveillance in Emilia-Romagna Region.
Description of the Problem
The Emilia-Romagna's Reference Centre for AFP surveillance, in collaboration with the regional Public Health Service identified a collaborative network for AFP Surveillance by analysing the 2015-2017 Hospital Discharge Registers in all region's hospitals. The surveillance protocol was reviewed with the development of a computerized system of Active Surveillance-Zero Reporting sent by e-mail to doctors in the network every 15 days since October 2018. The goal was to restore the AFP notification system to meet WHO requirements sensitivity, completeness of case investigation, completeness of follow-up and to monitor the active surveillance program adherence.
Results
The active surveillance network was composed by 49 doctors from both hospital administrations and clinical wards from 4 University Hospitals and 7 Local Health Authorities throughout the region. By the end of 2019, the mean response to each e-mail was 48.5% (SD 7.5%); 7 AFP cases have been reported; 85.7% received a full clinical and virological investigation and 83.3% completed the 60 day's follow-up. The final diagnosis of the cases was: 3 Guillain-Barre, 1 transient polyneuritis after HAV vaccination, 1 neuromyopathy from chronic disease, 1 acute myelitis in patient with DADA2. In 2 cases the paralysis persisted after 60 days.
Lessons
In 2019, the active surveillance system reached sensitivity, completeness of case investigation and follow-up required. Intervention had no expenses, is easily reproducible, created a direct collaboration between clinical colleagues in the network and the reference center which restored adherence to AFP surveillance.
Key messages
This work proposes how to improve AFP surveillance in a setting with low polio risk perception due to the absence of cases. Additionally, it reinforces the importance of direct collaboration/teamwork between institutions, regional reference centres and clinicians.
Insulin pump exposed to radioactive iodine Magdaleno, Angela L.; Koshy, Sharmila C.; Colucci, Karen M. ...
Clinical case reports,
December 2018, Letnik:
6, Številka:
12
Journal Article
Recenzirano
Odprti dostop
Key Clinical Message
Insulin pumps are not typically assessed for malfunction after exposure to significant radiation. We assessed an insulin pump kept for 48 hours on a patient on hemodialysis who ...required radioactive iodine ablation treatment for thyroid cancer. On download inspection, the pump showed normal function.
Insulin pumps are not typically assessed for malfunction after exposure to significant radiation. We assessed an insulin pump kept for 48 hours on a patient on hemodialysis who required radioactive iodine ablation treatment for thyroid cancer. On download inspection, the pump showed normal function.
Objective This study was undertaken to quantify tissue factor (TF) and vascular endothelial growth factor (VEGF) in colorectal cancer and to evaluate their possible relationship with recurrence.
...Method TF and VEGF were measured by enzyme‐linked immunosorbent assay in surgical tumour specimens and normal mucosa from 50 consecutive patients with colorectal cancer who were followed up for 3 years for the assessment of disease recurrence.
Results TF and VEGF antigens were detected in all tumour samples. VEGF, but not TF, was much higher in tumour than in normal mucosa (P < 0.0001), as also confirmed by measurement of specific mRNAs. There was a strong correlation between TF and VEGF antigens (P < 0.0005) in tumour tissue but not in normal mucosa. Neither protein was related to tumour stage, grade or size. Local or distant recurrence was statistically related to pTNM stage. High VEGF, but not TF, levels in tumour extracts were associated with an increased risk of recurrence both by univariate (RR, 4.00, 95% CI: 1.45–11.0) and multivariate analyses (RR, 3.65, 95% CI: 1.33–10.0).
Conclusion These findings suggest that VEGF content in colorectal cancer is an independent risk factor for tumour recurrence and might help select patients who might benefit from adjuvant therapy.
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