Post vaccinal temporary sensorineural hearing loss

In our systematic research we identified four studies concerning the onset of neurological adverse events following vaccination and two excluding this association. A 33-year-old Italian man, belonging to the Italian Army was hospitalized because he suffered from vertigo, nausea and sudden right hearing loss not classified (NDD), that set in 24 h after the administration of tetanus-diphtheria and meningococcal vaccines. Some neurological events arising after vaccination are very difficult to treat. In our case, the functional recovery on low and medium frequencies was possible about 6 months after the morbid event

Benzene and lipid asset

Background: In relation to the medico-social and medico-legal aspects of urban pollution we studied the effects of benzene present in urban pollution on outdoor workers exposed to physical, chemical, and psychosocial stressors. The purpose of this study is to evaluate the possible correlation between the levels of benzene and its urinary metabolites in the blood (Trans muconic acid and S-phenylmecapturic acid) and the parameters of the lipid structure: Total cholesterol, High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), triglycerides and blood sugar. Materials and methods: From an initial group 1,500 we selected a group of 199 subjects. A blood sample was taken for each worker to assess blood benzene levels and urinalysis to determine the levels of trans, trans-muconic acid and S-phenyl mercapturic acid. We compared the mean and standard deviation of the following lipid parameters: Total Cholesterol, HDL, LDL, Triglycerides and glycemia with benzene and urinary metabolites; we excluded the workers with confounding factors and performed the Pearson’s correlation between lipid parameters and urinary metabolites in the total sample and also among age, seniority, sex and BMI; multiple linear regression was performed for the evaluation of the main confounding factors. Results: We did not find a statistically significant alteration between the values of the lipid structure between the two groups of workers and the parameters of benzene. Triglycerides and HDL are statistically significantly influenced by sex (p=0.001) and (p=0.00) and BMI (p=0.00) and (p=0.001) as well as total cholesterol is influenced in a statistically significant way from age (p=0.003) and blood glucose from BMI (p=0.002) A statistically significant difference was found among the averages of phenylmercapturic S acid values of traffic policeman and police drivers (p<0.05), where higher values were among drivers. Conclusions: The results suggest that occupational exposure to levels of benzene, present in urban pollution, would appear not to influence the values of the lipid parameters in traffic policeman

Comparison between Rapid Intraoperative and Central Laboratory Parathormone Dosage in 12 Kidney Transplant Candidates

Background The rapid intraoperative parathormone (PTH) and at central laboratory PTH dosage gives similar results. The central laboratory provides results in longer times and higher costs. Intraoperative measurement can reduce time and costs during parathyroidectomy. Methods Twelve patients undergoing parathyroidectomy for hyperparathyroidism renal transplant candidates were included. Diagnosis was made by laboratory tests (serum calcium, PTH) and imaging techniques (ultrasonography and scintigraphy). All patients presented PTH levels of >400 pg/mL (the limit value to be maintained in list for kidney transplantation) and resistant to medical therapy. For each patient, 2 blood samples were collected before surgery at anesthesia induction for PTH testing intraoperative (rapid assay) and central laboratory, and 10 minutes after the removal of each gland. The times from collection-processing to communication to the surgeon of the results were compared for both the methods. It was considered successful the abatement of PTH of ≥70% at rapid intraoperative testing and consequently surgical intervention stopped before communication of central laboratory PTH testing. Results The average time of reporting the test results of the central laboratory was 41.5 minutes (SD ± 9), whereas with the rapid intraoperative PTH (ioPTH) testing the average time was 9.9 minutes (SD ± 2.02). An average of 33.6 minutes of the duration per intervention (SD ± 10.27) were virtually saved with the use of ioPTH testing. The 2 values of the Pearson correlation (ρ) of 0.99 obtained (for baseline) and 0.975 (for the 10-minute) lead us to conclude that there is an excellent correlation between the series of data. Conclusions Rapid ioPTH testing, owing to its accuracy, permits a dramatic reduction of operating time for patients with secondary hyperparathyroidism that need to be treated before inclusion on the waiting list

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

CONOSCENZA E PRATICA DELLE PRECAUZIONI STANDARD TRA I LAVORATORI SANITARI NELL’AREA OVEST DELLA CITTÀ DI LUSAKA

Riassunto. Introduzione. Nei paesi a basso reddito le precauzioni standard (SP) sono spesso praticate parzialmente esponendo gli operatori sanitari a un rischio di infezione evitabile (1). Scopo di questo studio è quello di investigare il livello di compliance con le SP tra gli operatori sanitari di strutture sanitarie di Lusaka. Materiali e Metodi. Lo studio è stato condotto da febbraio ad aprile 2016 in 44 lavoratori(23 uomini, 21 donne) di 9 strutture sanitarie della città di Lusaka. Per esaminare la consapevolezza e la conoscenza delle SP è stato consegnato ai lavoratori un questionario mirato e autosomministrabile, sviluppato in inglese dopo un approfondito esame della letteratura riferita all’Africa sub-sahariana (2,3). Il questionario comprende 43 domande su: dati socio-demografici; conoscenze sulla prevenzione delle infezioni; pratica dei lavoratori nella prevenzione delle infezioni Risultati. Solo il 47,8% dei lavoratori maschi vs 85,7% delle lavoratrici non indossa lo stesso paio di guanti per più pazienti, anche in assenza di contaminazione visibile (p=0.0114). La prevalenza dell’esposizione da taglio è significativamente maggiore nelle donne rispetto agli uomini (p=0.0144), senza differenze per l’esposizione muco cutanea. La prevalenza di infortuni biologici per reincappucciamento delle siringhe è maggiore nel sesso femminile (p=0.0001). Meno del 30% dei lavoratori dei due sessi pratica la profilassi post-esposizione. Una percentuale significativamente minore di lavoratrici rispetto ai lavoratori pratica disinfezione con alcool (p=0.0396). Le lavoratrici più dei lavoratori percepiscono le SP come impedimento allo svolgimento del lavoro (p=0.0420). I lavoratori di sesso maschile ritengono che la finalità delle precauzioni sia di proteggere il personale sanitario (p=0.0018); la protezione dei pazienti dall’essere infettati dal personale sanitario è considerata più rilevante dagli uomini (p=0.0291) così come la protezione del personale nella manipolazione di rifiuti infettivi e taglienti (p=0.0022 e p=0.0001). Conclusioni. I nostri dati evidenziano una grave sottovalutazione del rischio biologico. La percezione delle SP e del rischio lavorativo nel contesto studiato, ci inducono a ritenere che, la sicurezza sul lavoro non faccia parte dello svolgimento delle mansioni ordinarie ma sia piuttosto un corpo normativo “calato dall’alto”

Protocolli sanitari vaccinali per il personale militare e civile impiegato nei recenti teatri operativi: Gibuti, Iraq e Somalia

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Blood pressure in indoor and outdoor workers

Introduction: The aim of our study is to evaluate the changes in systolic and diastolic blood pressure in two occupational categories: outdoor workers (traffic policemen and environment technicians) and indoor workers. Materials and methods: The study was conducted comparing the results obtained from three samples of male workers: 175 outdoor traffic policemen, 175 outdoor environment technicians and 175 indoor workers. The outdoor and indoor groups were made comparable by age, length of service, body mass index, alcohol consumption, smoking status. Results: The mean values of systolic and diastolic blood pressure were found higher in traffic policemen and technicians than in indoor workers, as well as higher values of systolic blood pressure in traffic policemen than in technicians. Conclusions: The results suggest that outdoor working affects the blood pressure, contributing to an increased cardiovascular risk