Ebola virus infection among western healthcare workers unable to recall the transmission route

Introduction. During the 2014-2016 West-African Ebola virus disease (EVD) outbreak, some HCWs from Western countries became infected despite proper equipment and training on EVD infection prevention and control (IPC) standards. Despite their high awareness toward EVD, some of them could not recall the transmission routes. We explored these incidents by recalling the stories of infected Western HCWs who had no known directly exposures to blood/bodily fluids from EVD patients. Methodology. We carried out conventional and unconventional literature searches through the web using the keyword "Ebola" looking for interviews and reports released by the infected HCWs and/or the healthcare organizations. Results. We identified fourteen HCWs, some infected outside West Africa and some even classified at low EVD risk. None of them recalled accidents, unintentional exposures, or any IPC violation. Infection transmission was thus inexplicable through the acknowledged transmission routes. Conclusions. We formulated two hypotheses: inapparent exposures to blood/bodily fluids or transmission due to asymptomatic/mildly symptomatic carriers. This study is in no way intended to be critical with the healthcare organizations which, thanks to their interventions, put an end to a large EVD outbreak that threatened the regional and world populations

The face of Ebola: changing frequency of haemorrhage in the West African compared with Eastern-Central African outbreaks

BACKGROUND: The West-African (WA) Zaire Ebolavirus disease (EVD) outbreak was characterized by an exceptionally high number of cases and deaths as compared with the Eastern-Central African (ECA) outbreaks. Despite the Zaire Ebolavirus being the most lethal for humans, case-fatality rate, close to 80 % in ECA outbreaks, almost halved to 47 % in Guinea-Liberia-Sierra Leone (WA). Such an improvement was due to the remarkable implementation of international humanitarian aids. Some studies also suggested that the long human-to-human transmission cycle occurred in WA, gave rise to human adaptation and consequent immune escape. Haemorrhage, the main feature in seriously infected EVD patients, is due to the immune system that triggers the infected endothelial cells which expose the spike-like glycoprotein (GP) of the virion on their surface. If the human adaptation hypothesis holds true, the proportion of EVD patients with haemorrhage in the WA outbreak should be lower than in the ECA outbreaks due to immune escape. Therefore, the aim of this meta-analysis was to compare the relative frequencies of three typical haemorrhagic symptoms (conjunctival -CB, nasal -NB, gingival -GB- bleedings) in the ECA and WA outbreaks. METHODS: Literature searches were performed through PubMed and Scopus using generic keywords; surveys including at least ten patients reporting CB, NB, GB relative frequencies were extracted and split into ECA and WA. The meta-analytical methods chosen were based on the levels of between-study heterogeneity and publication bias. Pooled CB, NB, GB relative frequencies in ECA and WA were estimated and compared. Subgroup analysis including only studies on Zaire Ebolavirus also was performed. RESULTS: Fifteen studies (10 ECA, 5 WA) were located with 4,867 (CB), 3,859 (NB), 4,278 (GB) EVD patients overall. GB pooled relative frequency was 45.3 % (95 % confidence interval -95 CI, 34.7-56.1 %) and 18.0 % (95 CI, 6.0-34.5 %), in ECA and WA; NB was 10.6 % (95 CI, 5.7-16.8 %) and 1.3 % (1.0-1.8 %); GB was 24.2 % (95 CI, 11.9-39.2 %) and 1.9 % (95 CI, 1.4-2.4 %). Subgroup analysis confirmed these results. CONCLUSIONS: During the WA outbreak the relative frequency of GB decreased by two thirds, while NB and GB almost disappeared, suggesting that the Zaire Ebolavirus human adaptation hypothesis is plausible

Rapporto tra deficit cognitivo lieve e parodontite. Studio osservazionale in un campione di pazienti geriatrici

a popolazione mondiale sta celermente invecchiando e parallelamente aumenta il numero di persone affette da demenza, le quali mostrano gravi difficoltà intellettive e motorie, con perdita totale o parziale di autosufficienza, che si riflette significativamente su parenti e società. La demenza è un importante problema di salute pubblica, in quanto costituisce la causa principale di incapacità a lungo termine nella terza età. È ormai largamente riconosciuto che la malattia parodontale si possa andare ad associare a numerosissimi disordini sistemici legati alla salute dell’individuo. Più di recente alcuni studi hanno rilevato la correlazione tra l’infezione parodontale legata a diverse specie batteriche del cavo orale e l’eziologia del decadimento cognitivo. È stato osservato come, generalmente, la diagnosi della parodontite si basa sulla presenza ed entità dell’infiammazione gengivale, spesso misurata come livello di attacco (CAL), profondità di tasca (PD) ed estensione della perdita di osso alveolare, quest’ultima valutata radiograficamente. Lo stato di Mild Cognitive Impairment (MCI), in italiano compromissione cognitiva lieve, nota anche come disturbo neurocognitivo minore (nel DSM V) è una condizione diagnosticata agli individui che hanno deficit cognitivi che sono maggiori rispetto a quelli che statisticamente si possono aspettare per la loro età e istruzione, ma che non interferiscono significativamente con le loro attività giornaliere. Partendo dai presupposti che la MCI è spesso considerata come precursore dello stato di demenza, un’eventuale associazione tra quest’ultima e la malattia parodontale, attualmente non verificata da nessuno studio, potrebbe influenzare significativamente gli approcci terapeutici nei confronti di entrambe le patologie. Perciò se da un lato, l’obiettivo della ricerca proposta con tale tesi è quello di verificare una possibile correlazione tra MCI e parodontite, dall’altro lato è essenziale menzionare i già avvenuti studi relativi al deterioramento cognitivo ed altre problematiche dentali. Un recente meta analisi del 2019 di Nangle MR et Al. ha fornito prove di un'associazione tra apprendimento e memoria, attenzione complessa e funzione esecutiva con la salute orale in età avanzata. Il nostro studio ha avuto lo scopo principale di valutare se la profondità di tasca (PD) che è considerata indice ideale di malattia parodontale è associata in qualche modo al Mild Cognitive Impairment (MCI). È stato effettuato uno studio di tipo osservazionale. I pazienti oggetto di studio presentavano caratteristiche peculiari necessarie ed uguali per tutti, dovevano essere affetti da un deficit cognitivo e quindi presentare la diagnosi di MCI ma non di Alzheimer, non dovevano presentare una diagnosi di depressione, non dovevano mostrare edentulia in ultimo non dovevano essere sottoposti a trattamento parodontale. Non essendoci studi scientifici precedenti per calcolare il numero di pazienti necessario abbiamo deciso di selezione un campione consecutivo di 50 pazienti. Si è giunti alla conclusione finale che sussiste una correlazione tra la parodontite e il MCI, seppur non molto forte. Detto ciò la malattia parodontale è correlabile ad un deficit cognitivo lieve, spesso condizione antecedente di demenze più gravi. Tale conclusione pone un importante accento sul ruolo che l’odontoiatra o l’igienista dentale rivestono nell’ambito della prevenzione, poiché la dimensione cognitiva che maggiormente diminuisce in relazione alla parodontite è l’attenzione. Tanto premesso è naturale che l’odontoiatria o l’igienista dentale possano osservare, analizzare e comprendere un deficit dell’attenzione, tramite, ad esempio, semplici domande raccolte durante la compilazione della cartella clinica e durante l’aggiornamento della stessa nelle sedute successive; non solo, anche tramite il feedback relativo all’educazione e istruzione di specifiche manovre di igiene domiciliare, i professionista sanitari possono comprendere se il paziente mostra un deficit di attenzione o memoria. La possibilità di intercettare precocemente la condizione clinica di MCI permette di indirizzare subito il paziente verso cure e trattamenti specifici al fine di eludere la possibilità di un’evoluzione successiva verso il morbo di Alzheimer. Quindi data la scarsità di studi relativi ai meccanismi eziopatogenetici tra la parodontite e l’Alzheimer e date la carenze comportamentali dei pazienti affetti dal morbo, attualmente non è possibile comprende se è la malattia di Alzheimer ad essere responsabile della parodontite o viceversa, ma sicuramente grazie a questo studio osservazionale, sappiamo che il Mild Cognitive Impairment è associato con la malattia parodontale e perciò intercettare tali due condizioni può significare diagnosticare precocemente una condizione patologica come l’Alzheimer, per la quale non esiste ancora un trattamento farmacologico efficace e risolutivo

Nano-TiO2-based photocatalytic disinfection of environmental surfaces contaminated by meticillin-resistant Staphylococcus aureus

Background: Traditional cleaning and disinfection methods are inefficient for complete decontamination of hospital surfaces from meticillin-resistant Staphylococcus aureus (MRSA). Additional methods, such as nano-TiO2-based photocatalytic disinfection (PCD), could be helpful. Aim: To evaluate anti-MRSA activity of PCD on polyvinyl chloride (PVC) surfaces in naturallike conditions. Methods: Two identical PVC surfaces were used, and nano-TiO2 was incorporated into one of them. The surfaces were contaminated with MRSA isolated from hospitalized patients using a mist sprayer to simulate the mode of environmental contamination caused by a carrier. MRSA cell density was assessed before contamination until 180 min after contamination using Rodac plates. The differences between test and control surfaces in terms of MRSA density and log MRSA density reduction were assessed using parametric and non-parametric statistical tests. Five strains were tested, and each strain was tested five times. Findings: The highest median MRSA densities [46.3 and 43.1 colony-forming units (cfu)/ cm2 for control and test surfaces, respectively] were detected 45 min after contamination. Median MRSA densities 180 min after contamination were 10.1 and 0.7 cfu/cm2 for control and test surfaces, respectively (P<0.01). Log MRSA density reduction attributable to PCD was 1.16 log cfu/cm2 , corresponding to 93% reduction of the baseline MRSA contamination. Conclusions: The disinfectant activity remained stable throughout the 25 testing occasions, despite between-test cleaning and disinfection. The anti-MRSA activity of PCD was compatible with the benchmark for surface hygiene in hospitals (<1 cfu/cm2 ), but required 3 h of exposure to photocatalysis. Thus, PCD could be considered for non-clinical surfaces. However, for clinical surfaces, PCD should be regarded as supplemental to conventional decontamination procedures, rather than an alternative

General dental practitioners and hearing impairment

Objective: Hearing impairment (HI) remains a problem among dentists Hearing loss at speech frequencies was recently reported among dentists and dental hygienists. This study aimed to investigate prevalence and factors associated with perceived HI among dentists. Methods: In 2009-2010, 100 general dental practitioners (GDPs) and 115 general (medical) practitioners (GPs) (mean ages, 43.7 and 44.4 years) from Rome (Italy), who commenced practice &gt;= 10 years ago, were interviewed on a series of occupation- and recreation-related HI risk factors and on HI-associated symptoms (tinnitus, sensation of fullness, hypoacusis). Prevalence of presumptive HI (&gt;= 1 symptom perceived during workdays and weekends) was assessed and factors associated with presumptive HI were investigated. Results: Prevalence was 30.0% (95% confidence interval, 21.0-39.0%) and 14.8% (95% confidence interval, 8.3-21.3%) among GDPs and GPs, respectively. Occupation (GDP vs. GP), family history of hypoacusis, hypertension, ear diseases and smoking were significantly associated with presumptive HI. Within GDPs alone, significant associations were found for frequent use of ultrasonic scalers, use of dental turbines aged &gt;= 1 year and prosthodontics as prevalent specialty. Conclusions: GDPs experienced HI risk than GPs. Such a risk was not generalized to all dentists, but was specific for those who frequently used noisy equipment (aged turbines, ultrasonic scalers) during their daily practice. Clinical significance: GDPs with 10 or more years of practice who routinely use potentially noisy equipment, could be at risk of HI. In order to prevent such condition, daily maintenance and periodical replacement of dental instruments is recommended. (c) 2012 Elsevier Ltd. All rights reserved

Antibody level and immunity against hepatitis b virus infection among general dental practitioners

Introduction: Immunization against Hepatitis B virus (HBV) is crucial for an effective control in dental healthcare settings. Nevertheless, vaccination rates among general dental practitioners (GDPs) from developed countries range between roughly 50%, as in Italy and Japan, and >90% as in US and UK. Furthermore, vaccination does not necessarily imply immunity, as serum anti-HBs antigen (Ag) level tends to decrease and booster doses are periodically required. Aim: To investigate HBV vaccination and immunity rates among Italian GDPs. Material and methods: 195 GDPs voluntarily participated. They provided information regarding HBV vaccination in the last 10 years and underwent blood samples to detect serum anti-HBs Ag level. Immune subjects were considered subjects with anti-HBs Ag =10 mIU/mL. Vaccination and immunity rates were assessed with 95% confidence intervals (95CIs). Sensitivity (proportion of immune GDPs among vaccinated GDPs), Specificity (proportion non-immune GDPs among non-vaccinated GDPs) also were assessed. Results: 88% GDPs were vaccinated (95CI, 83-92%), but only 83% were immune (95CI, 77-88%). Sensitivity was 95.6%, suggesting that among immune GDPs, 4.4% were not recently vaccinated. Specificity was 50%, suggesting that among nonimmune GDPs, 50% were recently vaccinated. Conclusion: Vaccination rate among Italian GDPs was high. Nevertheless, a fraction of 5% of them was vaccinated but was not immune, thus suggesting that serum antibody level should be periodically checked because susceptible GDPs are at risk for HBV infection. © 2013 Medicinski fakultet Niš

Dentists' awareness toward vaccine preventable diseases

Effective infection control in dentistry is unfeasible without an adequate immunization program for dental health care providers (DHCPs). Such an assumption is demonstrated for some vaccine preventable infectious diseases (VPIDs), such as Hepatitis B. Influenza and Varicella. However, excluding Hepatitis B vaccine, immunization programs for DHCPs are few and often unclear about which vaccinations are recommended, thus leading to generally low awareness and consequent low vaccination rates. This survey investigated dentists' awareness toward VPIDs. At the moment of registration to a dental congress, a questionnaire regarding the immunization status toward VPIDs was anonymously filled in by 379 Italian dentists (86% of the contacted dentists), with at least fifteen years of activity. DHCP specific awareness was considered high if dentists reported to have controlled the serum level of anti-HBs during the last ten years and have received seasonal influenza vaccine annually. Awareness toward VPIDs was classified high if dentists reported to be immune against six or seven of the following V1PDs, Hepatitis B, Influenza, Varicella, Measles, Mumps, Rubella and Tetanus. DHCP specific awareness resulted high for 32.5% of subjects and low for 31.1%. None of the subjects reported high awareness toward VPIDs. while for 60% of them, such awareness was low (immunization status reported for none or one of the seven VPIDs). Low dentists' awareness stresses the need for a transparent immunization program which is effective in controlling VPID transmission in the dental health care settings and focuses on those VPIDs which pose a true risk of infection for DHCPs and patients. (C) 2011 Elsevier Ltd. All rights reserved

Antibiotic resistance and defensive medicine, a modern challenge for an old problem: the case of Ureaplasma urealyticum

The practice of defensive medicine is an emerging problem in public health. A common practice of defensive medicine is excessive antibiotic prescribing which is well known to lead to antibiotic resistance, an important public health priority worldwide, not only for its clinical implications (increased morbidity, mortality, duration of illness, frequent development of complications and outbreaks), but also for the economic impact of antibiotic-resistant infections which lead to additional costs related to the use of more expensive drugs and procedures and to longer length of illness and hospital stays. Also, the emergence of pathogens resistant to multiple antibiotics reduces the possibility of an effective treatment. The present study investigated susceptibility to antibiotics of 115 strains of Ureaplasma urealyticum identified in urethral swabs. Patients who provided samples had a mean age of 41 years. Strains were 96% resistant to ciprofloxacin and 99% sensitive to doxycycline and pristinamycin and 98% to josamycin. Results were comparable to those of a previous study by Savarino and Mattei