Environmental exposure to arsenic and chromium in an industrial area

Arsenic and chromium are widespread environmental contaminants that affect global health due to their toxicity and carcinogenicity. To date, few studies have investigated exposure to arsenic and chromium in a population residing in a high-risk environmental area. The aim of this study is to evaluate the exposure to arsenic and chromium in the general population with no occupational exposure to these metals, resident in the industrial area of Taranto, Southern Italy, through biological monitoring techniques. We measured the levels of chromium, inorganic arsenic, and methylated metabolites, in the urine samples of 279 subjects residing in Taranto and neighboring areas. Qualified health staff administered a standardized structured questionnaire investigating lifestyle habits and controlling for confounding factors. The biological monitoring data showed high urinary concentrations of both the heavy metals investigated, particularly Cr. On this basis, it will be necessary to carry out an organized environmental monitoring program, taking into consideration all exposure routes so as to correlate the environmental concentrations of these metals with the biomonitoring results

Effectiveness and Safety of Transthoracic Ultrasound in Guiding Percutaneous Needle Biopsy in the Lung and Comparison vs. CT Scan in Assessing Morphology of Subpleural Consolidations

(1) Background: The aim of this study was to conduct a prospective analysis on the diagnostic accuracy of transthoracic ultrasound-guided percutaneous needle biopsy (TUS-PNB) for the histological assessment of peripheral lung lesions and to assess the performance of transthoracic ultrasound (TUS) examination vs. chest CT (gold standard) in the differentiation between malignant and benign peripheral lung lesions. (2) Methods: A total of 961 consecutive patients with subpleural pulmonary lesions were enrolled. All the patients received a CT scan with contrast; 762 patients underwent TUS-PTNB for suspicion of malignancy, and the remaining 199 enrolled patients underwent only TUS examination as a part of routine follow-up for known non-malignant subpleural consolidations. (3) Results: Among the 762 TUS-guided biopsies, there were 627 (82.28%) malignant lesions, 82 (10.76%) benign lesions, and 53 (6.96%) indeterminate lesions. The overall diagnostic accuracy was 93.04%. The rates of pneumothorax not requiring chest-tube insertion and self-limited hemoptysis were 0.79 and 0.26%, respectively. Patients were divided into two groups based on the benign or malignant nature of the subpleural consolidations. On TUS, both malignant and benign lesions showed mostly irregular margins and a hypoechoic pattern, but no differences were assessed in terms of sonographic margins and pattern between the two groups. There was poor agreement between TUS and chest CT in assessing air bronchograms and necrotic areas. The only finding in the detection of which TUS showed superiority compared to chest-CT was pleural effusion. (4) Conclusions: TUS-PNB was confirmed to be an effective and safe diagnostic method for peripheral pulmonary consolidation, but their sonographic pattern did not allow to rule out a malignant nature. A pre-operative evaluation on CT images, combined with the possibility of performing additional immunohistochemical and cytological investigations and the experience of the medical staff, may improve the diagnostic yield of TUS-guided biopsies

Association between Long COVID and Overweight/Obesity

Background: Long COVID is a syndrome characterized by the persistence of SARS-CoV-2 infection symptoms. Among HCWs, prolonged COVID symptoms could lead to the inability to perform work tasks. The aim of this study is to investigate 35-day long-COVID (35-LC) characteristics and risk factors in a one-year period. Methods: We carried out a retrospective cohort study during the COVID-19 pandemic at University Hospital of Bari. A total of 5750 HCWs were tested for close contact with a confirmed case, in the absence of personal protective equipment, or for symptom development. Results: Each positive HCW was investigated for cardiovascular risk factors or respiratory diseases. An amount of 352 HCWs (6.1%) were infected by SARS-CoV-2, and 168 cases evolved to long COVID. The 35-LC group showed mean BMI values higher than the non-35-LC group (25.9 kg/m2 vs. 24.8 kg/m2, respectively), and this difference was significant (p-value: 0.020). Moreover, HCWs who suffered from pulmonary disease (OR = 3.7, CL 95%: 1.35–10.53; p-value = 0.007) or overweight (OR = 1.6 CL 95%: 1.05–2.56; p-value = 0.029) had an increased risk of developing 35-LC. Conclusions: Long COVID is an emerging problem for hospital managers as it may reduce the number of HCWs deployed in the fight against COVID-19. High BMI and previous pulmonary disease could be risk factors for 35-LC development in exposed HCWs

transthoracic ultrasound versus intraoperative ultrasound in patients with pulmonary fibrosis reappraisal of artifacts

In the last years, transthoracic ultrasound (TUS) has regained a growing interest from both clinicians and radiologists as a useful and non-invasive diagnostic tool for the study of many pleuro-pulmonary conditions, including interstitial lung diseases. Intraoperative lung ultrasound (ILU) is an ultrasound technique, developed for lung surface assessment during video-assisted thoracoscopic surgery procedures. It has been developed considering ultrasound basic physics principles for images generation and interpretation. Most of the TUS findings are due to the high difference in acoustic impedance between the chest-wall structures and the air in the lungs. In this brief communication, we compared ILU and TUS images in interstitial lung diseases. Most of the TUS artifacts-based diagnostic algorithms should be reappraised

factors underlying the development of chronic temporal lobe epilepsy in autoimmune encephalitis

Abstract Purpose Limbic encephalitis (LE) is an autoimmune condition characterized by amnestic syndrome, psychiatric features and seizures. Early diagnosis and prompt treatment are crucial to avoid long-term sequelae, including psycho-cognitive deficits and persisting seizures. The aim of our study was to analyze the characteristics of 33 LE patients in order to identify possible prognostic factors associated with the development of chronic epilepsy. Methods This is a retrospective cohort study including adult patients diagnosed with LE in the period 2010–2017 and followed up for ≥12 months. Demographics, seizure semiology, EEG pattern, MRI features, CSF/serum findings were reviewed. Results All 33 LE patients (19 M/14F, mean age 61.2 years) presented seizures. Thirty subjects had memory deficits; 22 presented behavioural/mood disorders. Serum and/or CSF auto-antibodies were detected in 12 patients. In 31 subjects brain MRI at onset showed typical alterations involving temporal lobes. All patients received immunotherapy. At follow-up, 13/33 had developed chronic epilepsy; predisposing factors included delay in diagnosis (p = .009), low seizure frequency at onset (p = .02), absence of amnestic syndrome (p = .02) and absence/rarity of inter-ictal epileptic discharges on EEG (p = .06). Conclusions LE with paucisymptomatic electro-clinical presentation seemed to be associated to chronic epilepsy more than LE presenting with definite and severe "limbic syndrome"

Deep Vein Thrombosis of Saphenous-Femoral Junction After Leg Lauromacrogol Foam Ultrasound Guided Percutaneous Sclerotherapy

Background: Lauromacrogol foam sclerotherapy is characterized by a high success rate in obliterating varicose veins and a low frequency of adverse effects. Most of these parts consist of minor effects, and few data are available about significant effects (e.g., vein thrombosis), pointing out the technical safety of ultrasound-guided foam sclerotherapy.Case Presentation: a 78-year-old woman was evaluated for chronic vein disease; at ultrasonographic and Doppler scan (USDS), severe GSV dilatation and GSV reflux were documented in both legs below the knee. After meticulous anamnesis and physical examination, informed consent was obtained, and ultrasound-guided percutaneous polidocanol foam (one part of 2% lauromacrogol solution + one part of the air, mixed with Double Syringe System) sclerotherapy was performed in the right leg; best medical therapy was given after the procedure. After five days, USDS pointed out thrombosis extending to the thigh upper region to saphenous-femoral junctions, consisting of deep vein thrombosis. Appropriate anticoagulant therapy was promptly dispensed, and the patient had no aftermaths.Conclusion:The prevalence of vein thrombosis after lauromacrogol sclerotherapy is unknown, and their correlation is uncertain, but, in our experience, it should be suspected in patients who referred lower limb pain after this procedure despite the best medical therapy dispensation.  

The impact of digitalization on the internationalization propensity of Italian family firms

Although the role of innovation and digitalization represents critical factors to succeed in the international context, there is a lack of empirical evidence on how they impact on the international propensity of family firms. We address this gap investigating to which extent family firms adopt digitalization tools and their effect on export-orientation, as well as whether the innovation can play a boosting role for family decision-makers. Based on a survey of 2,500 Italian firms carried out in 2015 by Italian Chambers of Commerce, we find that family firms face more difficulties in undertaking digital transformation decisions, since they can weaken family SEW endowment but digitalization solutions enable the international propensity of family firms, bridging the gap with their non-family counterparts. Theses results advance the current debate on risk preferences of family firms, taking into account firm conditions, in terms of digitalization and innovation equipment, under which family owners make strategic decisions

Tear Trough Deformity: Study of Filling Procedures for Its Correction

The aim of this work is to discuss the anatomy of the tear trough region with relative danger areas, and to describe 2 different options to correct this deformity.The tear trough is a concave deformity of the orbital fat that is noticeable as a result of inherited anatomic differences and aging. However, the periorbital region is a complex area with its own septa and ligaments, fat compartments, muscles, vascularization, and lymphatic drainage and presents anatomic characteristics that must be taken into account in order to achieve good results and avoid complications.The use of hyaluronic acid gel or autologous fat for soft tissue correction is a good option.A total of 96 patients with periorbital hollowing were divided into 2 groups; each group received a different treatment, from December of 2013 to December of 2015, with hyaluronic- or lipo-filling

Esposizione professionale alla luce fluorescente in una patologa con complicanze miopiche ed insorgenza di sintomi astenopici

Background: Pathologic myopia is often associated with many complications, e.g. retinopathy, vitreous detachment and glaucoma. To date, occupational exposure of workers suffering from myopic co-morbidities to fluorescence light is not clearly linked to a worsening of retinal damage and eye symptoms. Case report: A 56-year-old pathologist, suffering from myopic retinopathy and other ocular comorbidities, asked for medical examination due to worsening vision and burning eyes, after occupational exposure to fluorescence microscope. Eye examination performed by an ophthalmologist detected a severe chorio-retinal atrophy in peri-papillar region and scotopic-photopic reduced voltages at electroretinogram. Moreover, a workplace inspection noted high light intensity from power source (9600 lux). Considering severity of the retinopathy, frequency of the ocular symptoms and steady occupational exposure both to low-intensity fluorescent light and high intensity light, we decided to declare the worker only fit for specific tasks which do not include the use of a fluorescence microscope. Almost six months later, the worker was recalled for a new examination and she reported the absence of the ocular discomfort that had led her to request the previous examination. Conclusion: In this unconventional case, we considered appropriated to use great caution, to avoid ocular fatigue and prevent possible retinal damage in the worker