Developing approaches to control SARS-CoV-2 in a public hospital

The Territorial Public Health Care Company (in Italian, ASST) of the Saints Paolo e Carlo of Milano includes two large public hospitals, and several outpatients and territorial healthcare services. It employs 5642 workers. The outbreak of novel coronavirus disease 2019 (COVID-19) reached our ASST in the last week of February when a doctor in the Intensive Care Unit of the San Paolo Hospital was diagnosed with COVID-19. Our Occupational Health Unit immediately introduced measures to control the epidemic. Our approach was based on contact tracing and isolation of asymptomatic infected workers. A \u2018close contact\u2019 was defined as a person who had face-to-face contact or spent at least 15 min in an indoor environment with a positive subject (patient, colleague or relative) without any protective equipment (surgical mask). From 27 February to 23 April we tested 2907 workers (51% of the total workforce) with nasopharyngeal swabs (NPS) using rtPCR for SARS-CoV-2 detection [1,2], with positive results in 152 hospital and 33 territorial workers (3% of the total workforce). All the infected workers were asked to fill in a daily electronic data collection form for the duration of the infection. About 50% remained substantially asymptomatic for the quarantine period, which ended when the workers underwent two NPS on two consecutive days with a negative result. The time to recovery took from 12\u201347 days, with a median duration of about 30 days, which is longer than normally expected. Symptomatic workers showed only very mild symptoms; mainly loss/change of smell and taste. Four were hospitalized but none had severe or life-threatening infection. The data suggest that the \u2018active search approach\u2019 is more effective in closed communities such as groups of healthcare workers than generalized testing. We have started a retrospective survey of 100 positive workers studying symptoms, source of exposure and co-morbidities using a modified version of the \u2018WHO novel coronavirus acute respiratory infection clinical characterization data tool\u2019, administered by telephone interview. Finally, in order to prepare for future outbreaks, we are testing a novel telemedicine approach enabling us to follow quarantined workers with a digital platform with a mobile phone app that provides remote video examinations and online symptoms and health parameter checking (body temperature, oxygen saturation, etc.). The platform facilitates rapid intervention. Using this approach, we can follow a large cohort of workers with continuous monitoring. The tool may also be able to reduce the rate of patients\u2019 hospitalization. We are also comparing those with positive and negative swabs using a rapid immunochromatographic assay for the detection of IgG and IgM antibodies to SARS-CoV-2 virus in whole blood to assess potential immunity. Preliminary results are promising for IgG, even though the protective capacity of this immunoglobulin is still unknown

Assessment of penconazole exposure in winegrowers using urinary biomarkers

Penconazole (PEN) is a fungicide used in agriculture. The aim of this work was to evaluate the exposure to PEN in vineyard workers focusing on urinary biomarkers. Twenty-two agricultural workers were involved in the study; they were investigated during PEN applications and re-entry work, performed for 1-4 consecutive working days, for a total of 42 mixing and applications and 12 re-entries. Potential and actual dermal exposure, including hand exposure, were measured using pads and hand washes. Urine samples were collected starting before the first application, continuing during the work shift, and ending 48\u202fh after the last shift. The determination of PEN in dermal samples and PEN metabolites in urine was performed by liquid chromatography tandem mass spectrometry. Dermal potential body exposure and actual total exposure showed median levels ranging from 18 to 3356\ub5g and from 21 to 111\u202f\ub5g, respectively. Urinary monohydroxyl-derivative PEN-OH was the most abundant metabolite; its excretion rate peaked within 24\u202fh after the work shift. In this period, median concentrations of PEN-OH and the carboxyl-derivative PEN-COOH ranged from 15.6 to 27.6\u202f\ub5g/L and from 2.5 to 10.2\u202f\ub5g/L, respectively. The concentration of PEN-OH during the work shift, in the 24\u202fh after and in the 25-48\u202fh after the work shift were correlated with actual body and total dermal exposure (Pearson's r from 0.279 to 0.562). Our results suggest that PEN-OH in the 24\u202fh post-exposure urine is a promising candidate for biomonitoring PEN exposure in agricultural workers

Focused lung ultrasonography of calves (FLUC): valutazione di un protocollo rapido per la diagnosi ultrasonografica della broncopolmonite enzootica

Nella pratica buiatrica vengono comunemente usati gli score clinici che rappresentano un mezzo diagnostico pratico ed immediato per la diagnosi di broncopolmonite enzootica (BRD), nonostante la sensibilit\ue0 e la specificit\ue0 di questi score sia bassa (Calf respiratory score \u2013 CRS: sensibilit\ue0 55%, specificit\ue0 58%; auscultazione toracica: sensibilit\ue0 3-17%). L\u2019ecografia del torace, invece, \ue8 un esame molto accurato che permette di avere un quadro dei danni anatomici al polmone, difficilmente riscontrabili con altri mezzo diagnostici. Bench\ue9 il \u201clung ultrasonographic score system\u201d (LUS), rappresenti il \u201cgold standard\u201d per la valutazione delle alterazioni patologiche del polmone, questa tecnica si dimostra spesso indaginosa soprattutto per i veterinari che hanno poca dimestichezza con l\u2019ecografia toracica. Lo scopo di questo studio \ue8 stabilire la validit\ue0 di un protocollo ecografico rapido utilizzabile anche da veterinari senza esperienza in ecografia del torace, limitando la scansione a specifiche regioni dell\u2019area polmonare (lobi craniali) che vengono comunemente colpite in corso di BRD. Vitelli di razza frisona italiana con un\u2019et\ue0 compresa tra 30 giorni e 6 mesi, un punteggio di Calf respiratory score (CRS) maggiore a 5 e l\u2019assenza di patologie concomitanti sono stati selezionati come casi. Come controlli sono stati selezionati vitelli con le medesime caratteristiche ma con un punteggio del CRS inferiore a 5. Ogni vitello \ue8 stato sottoposto a visita clinica, a compilazione del CRS e a LUS. Immediatamente dopo la scansione ecografica, un operatore con scarsa esperienza ha effettuato la sola ecografia del V spazio intercostale di entrambi gli emitoraci (focused lung ultrasonography of calves; FLUC) utilizzando come marker ventrale la giunzione costo-condrale e la deviazione pleurica. Sono state calcolate sensibilit\ue0, specificit\ue0 e valori predittivi negativo e positivo per la presenza del consolidamento polmonare riscontrato tramite FLUC. Nello studio sono stati inclusi 26 vitelli (19 \u201cmalati\u201d e 7 \u201csani\u201d). Tramite esecuzione della FLUC nel gruppo \u201cmalati\u201d \ue8 stato possibile rinvenire consolidamento polmonare a livello del quinto spazio intercostale destro e/o sinistro in 17 animali su 19. I due animali che non presentavano consolidamento avevano numerosi artefatti a coda di cometa a livello del V spazio intercostale. Nel gruppo \u201csani\u201d la FLUC non ha riscontrato la presenza di consolidamento polmonare in nessun animale. Valutando gli animali tramite LUS, tutti gli animali inclusi nel gruppo \u201cmalati\u201d hanno mostrato uno score 65 2, mentre gli animali nel gruppo \u201csani\u201d hanno ottenuto uno score < 2. L\u2019accuratezza della FLUC, confrontata all\u2019ecografia totale dell\u2019area polmonare, \ue8 risultata essere pari all\u201985%. La sensibilit\ue0 \ue8 risultata essere 81% e la specificit\ue0 100%. Il valore predittivo positivo del test \ue8 stato pari al 100%, mentre il valore predittivo negativo 56%. La metodica FLUC si \ue8 rivelata essere una metodica pratica, rapida e facilmente eseguibile da un solo operatore, in grado di dare una buona rappresentazione della situazione polmonare. Pu\uf2 essere quindi considerato un ulteriore strumento per i veterinari di campo per raggiungere una precoce, accurata e corretta diagnosi della broncopolmonite enzootica con riferimenti riguardanti il tipo di lesioni, fondamentale per applicare un protocollo terapeutico efficace e risolutivo

Environmental and biological monitoring for the identification of main exposure determinants in vineyard mancozeb applicators

Grapevine is a vulnerable crop to several fungal diseases often requiring the use of ethylenebisdithiocarbamate (EBDC) fungicides, such as mancozeb. This fungicide has been reported to have goitrogenic, endocrine disrupting, and possibly immunotoxic effects. The aim of this study was to assess workers' exposure in two scenarios of mancozeb application and analyse the main determinants of exposure in order to better understand their mechanism of influence. Environmental monitoring was performed using a modified Organisation for Economic Co-operation and Development (OECD) "patch" methodology and by hand-wash collection, while mancozeb's metabolite, ethylenethiourea (ETU), was measured in 24-h preexposure and postexposure urine samples. Liquid chromatography-mass spectrometry was used for determination of mancozeb and ETU in different kinds of samples. Closed tractor use resulted in 40 times lower potential exposure compared with open tractor. Coveralls reduced skin exposure 4 and 10 times in case of open and closed tractors, respectively. Gloves used during application resulted in 10 times lower hand exposure in open but increased exposure in closed tractors. This study has demonstrated that exposure to mancozeb is low if safe occupational hygiene procedures are adopted. ETU is confirmed as suitable biological marker of occupational exposure to mancozeb, but the absence of biological exposure limits significantly reduces the possibility to interpret biological monitoring results in occupationally exposed workers

The Safe Use of Pesticides: A Risk Assessment Procedure for the Enhancement of Occupational Health and Safety (OHS) Management

The attention paid to the use of pesticides has increased notably in recent years as demonstrated by the issue of laws and regulations requiring their safe and environmentally-conscious use (e.g. Directive 2009/128/EC and Regulation (EC) no. 1272/2008). Despite the benefits that can be achieved by pursuing the targets of stricter legislative framework, the difficulties for farmers in complying with it are remarkable, especially for small-sized companies. In fact, in contrast to other occupational health and safety (OHS) contexts, in the case of pesticides even a preliminary analysis on the relationship between pesticide use and the consequent exposure risks for the workers is a complex task. In order to reduce the above-mentioned gap, the present study is focused on the development of an easy-to-use tool for carrying out occupational risk assessment of agricultural activities related to the use of pesticides. The procedure was developed by starting from the Agricultural Health Study (AHS) approach and its improvements, and continuing to the thorough development of a tool for preliminary risk assessment, providing a simplified model for its practical application by farmers. A case study concerning olive cultivation was used for its first verification. The results achieved should be considered as an initial step for the promotion of safer practices when using pesticides, providing a consistent base for their further validation

Immunologic status of agricultural workers in the region of Lombardy, Northern Italy

Purpose. Farming is associated with a wide variety of hazardous exposures including physical, chemicals and biological agents. Animal farmers are exposed to dust which contains microorganisms, mycotoxins, endotoxins, animal feed particles, allergens and chemical agents. Organic dust exposure is known to cause allergic and non-allergic rhinitis, and organic dust toxic syndrome. This study was undertaken to evaluate the relationship between occupational health hazards and serum pro-inflammatory cytokines among agricultural workers, in particular we investigated whether animal breeders react differently to biological agents than non breeder farmers. Methods. One hundred subjects working in agricultural enterprises in the region of Lombardy, were enrolled into the study in 2010. Serum cytokines including interleukin (IL)-6, IL-8, IL-10, IFN\u3b3 and tumor necrosis factor-\u3b1 (TNF\u3b1) were measured. Cytokines were assessed by commercially available enzyme-linked-immunosorbent assay (ELISA). Results of the study. Compared to control subjects, increased TNF-\u3b1, IL-8, and IL-10 levels were found in animal breeders, and a statistically significant relationship between type of job (breeder/non breeder workers) and increased serum pro-inflammatory cytokines. Results suggest that animal breeders might be at higher risk of occupational diseases and biological hazards than other farmers with less contact to animals

Sorveglianza sanitaria in agricoltura : l\u2019esperienza del Centro Internazionale per la Salute Rurale dell\u2019Azienda Ospedaliera San Paolo di Milano

OCCUPATIONAL HEALTH SURVEILLANCE IN AGRICULTURE: THE EXPERIENCE OF THE INTERNATIONAL CENTRE FOR RURAL HEALTH. The results of the activities of occupational health surveillance in agriculture carried out by the International Centre for Rural Health since 2008 are described.The activities involve 800 workers employed in 260 farms in the Region of Lombardy (Italy). The types of farms reflect the vocation toward agricultural sector of the Po Valley and the most representative tasks are related to animal care and use of agricultural machinery. Based on the specific risks, workers are provided with preventive and periodic examinations, and complementary laboratory and instrumental evaluations (hearing and respiratory functions, electrocardiography), related to the different risk factors present in the enterprises. The occupational health priorities identified are, for the time being, noise-induced hearing loss and insufficient immunization against tetanus

Splenic marginal zone lymphoma with or without villous lymphocytes. Hematologic findings and outcomes in a series of 57 patients

BACKGROUND. Splenic marginal zone lymphoma (SMZL) is a well defined pathologic entity. However, questions regarding the bone marrow infiltration rate, the minimal diagnostic data set, and therapy remain unanswered. METHODS. Clinical-pathologic features and outcomes of 57 consecutive patients who had splenomegaly with no clinically significant lymphadenomegaly and who were diagnosed with SMZL with or without (+/-) villous lymphocytes (VL) were reviewed. RESULTS. SMVL +/- VL occurred mostly in elderly males (median age, 62 years +/- 10 years; male-to-female ratio, (1.85). Anemia was recorded in 49% of patients, and 30% of patients had moderate thrombocytopenia. Leukocytosis and leukopenia were found in 33% and 14% of patients, respectively, and typical VL were found in 84% of patients. Serology for hepatitis C virus infection was positive in 16% of patients, and a small monoclonal component was detected in 36% of patients. The bone marrow was infiltrated with an intrasinusoidal component in all patients. Thirteen patients were monitored using a watch-and-see policy, and they remained alive 1-5 years after diagnosis. Overall, 21 patients (36%) underwent splenectomy; and, in all patients, the diagnosis of SMZL was confirmed histologically in the surgical specimens. Twenty-five patients received single-agent therapy, which included either alkylators or pentostatine, and they achieved an overall response rate (ORR) of 65% and 87%, respectively: Polychemotherapy was administered to 6 patients (ORR, 83%). The median survival for all patients in the series was not reached, and it is expected that 70% of patients will be alive at 5 years. CONCLUSIONS. Up to 20% of patients who had SMZL +/- VL could be monitored using a watch-and-wait policy. The bone marrow intrasinusoidal infiltration pattern may be a valuable diagnostic hallmark, thus obviating diagnostic splenectomy. The issues regarding prognostic stratification and the best therapeutic strategy need to be addressed in properly designed, prospective trials