Surveillance of paediatric exposures to liquid laundry detergent pods in Italy

Objective To analyse paediatric exposures to pod and traditional laundry detergents in Italy and changes in exposure trends. Methods Analyses of a series of patients aged <5 years and exposed to laundry detergents between September 2010 and June 2015, identified by the National Poison Control in Milan. Results In comparison with patients exposed to traditional laundry detergents (n=1150), a higher proportion of those exposed to pods (n=1649) were managed in hospital (68% vs 42%), had clinical effects (75% vs 22%) and moderate/high severity outcomes (13% vs <1%). Exposure rates were stable over time for traditional detergents (average 0.65 cases/day), but an abrupt decline in major company pods was seen in December 2012, 4 months after the introduction of opaque outer packaging (from 1.03 to 0.36 cases/day and from 1.88 to 0.86 cases/million units sold). The odds of clinical effects was higher for exposure to pods than for traditional detergents (OR=10.8; 95% CI 9.0 to 12.9). Among patients exposed to pods, the odds of moderate/high severity outcomes was four times higher for children aged <1 years than for the other age groups (OR=3.9; 95% CI 2.2 to 7.0). Ten children exposed to laundry detergent pods had high severity outcomes while no children exposed to traditional laundry detergents developed high severity effects. Conclusions The study confirms that exposure to laundry detergent pods is more dangerous than exposure to traditional detergents. In Italy, 4 months after the introduction of opaque outer packaging by a major company, product-specific exposure rates decreased sharply, suggesting that reducing visibility of laundry detergent pods may be an effective preventive measure. Further efforts are needed to improve safety

239 Surveillance of toxic exposures to liquid laundry detergents in pods in Italy

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Calprotectin in nasal secretion: a new biomarker of non-type 2 inflammation in CRSwNP

We analysed calprotectin in sinonasal secretions of different chronic rhinosinusitis with nasal polyps (CRSwNP) endotypes to assess its role as a biomarker of non-type 2 inflammation.We included primary diffuse CRSwNP patients (n = 41) and three different control groups [non-allergic rhinitis (NAR) (n = 13), non-allergic eosinophilic syndrome (NARES) (n = 10) and healthy subjects (n = 12)]. Calprotectin levels were detected in nasal secretions using a chemiluminescent immunoassay (CLIA).Calprotectin levels in nasal secretions were significantly higher in all non-type 2 endotypes of CRSwNP compared to healthy controls (p0.05). In contrast, in type-2 CRSwNP calprotectin was significantly lower compared to controls (p0.05). A significant correlation between calprotectin levels and neutrophilic count/HPF was found in CRSwNP (p0.01). Clinically, mean levels of calprotectin and neutrophilia were significantly higher in patients who previously underwent 3 or more endoscopic sinus surgeries (p0.05).Calprotectin in nasal secretions may be a biomarker of non-type 2 inflammation. Low levels of calprotectin are indicative of a type-2 immune response in both CRSwNP and non-allergic rhinitis. We observed that calprotectin levels significantly increased based on the number of previous surgeries.Calprotectina nel secreto nasale: nuovo biomarker di infiammazione non-tipo 2 nella poliposi nasale.Abbiamo analizzato i livelli di calprotectina nelle secrezioni nasali di diversi endotipi di CRSwNP, per valutarne il ruolo di marcatore di infiammazione non-tipo 2.Abbiamo incluso pazienti con CRSwNP diffusa primaria (n = 41) e tre diversi gruppi di controllo [rinite non allergica (NAR) (n = 13), rinite eosinofila non allergica (NARES) (n = 10) e soggetti sani (n = 12)]. I livelli di calprotectina sono stati dosati mediante test di chemoluminescenza.I livelli di calprotectina sono risultati significativamente più alti in tutti gli endotipi non-tipo 2 di CRSwNP, rispetto ai controlli sani (p0,05). Al contrario, nella CRSwNP tipo 2 essa è risultata inferiore rispetto ai controlli (p0,05). È stata riscontrata una correlazione significativa tra i livelli di calprotectina e la conta dei neutrofili/HPF (p0.01). I livelli medi di calprotectina aumentano inoltre nei pazienti in precedenza sottoposti a 3 o più ESS (p0,05).La calprotectina nelle secrezioni nasali può essere considerata un biomarcatore di infiammazione non-tipo 2 mentre bassi livelli di calprotectina sono indicativi di immunoflogosi di tipo 2. Abbiamo infine osservato che i livelli di calprotectina aumentano significativamente in relazione al numero di interventi chirurgici pregressi

Dupilumab in the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP): A multicentric observational Phase IV real-life study (DUPIREAL)

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with significant morbidity and reduced health-related quality of life. Findings from clinical trials have demonstrated the effectiveness of dupilumab in CRSwNP, although real-world evidence is still limited. Methods This Phase IV real-life, observational, multicenter study assessed the effectiveness and safety of dupilumab in patients with severe uncontrolled CRSwNP (n = 648) over the first year of treatment. We collected data at baseline and after 1, 3, 6, 9, and 12 months of follow-up. We focused on nasal polyps score (NPS), symptoms, and olfactory function. We stratified outcomes by comorbidities, previous surgery, and adherence to intranasal corticosteroids, and examined the success rates based on current guidelines, as well as potential predictors of response at each timepoint. Results We observed a significant decrease in NPS from a median value of 6 (IQR 5–6) at baseline to 1.0 (IQR 0.0–2.0) at 12 months (p < .001), and a significant decrease in Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score of 58 (IQR 49–70) at baseline to 11 (IQR 6–21; p < .001) at 12 months. Sniffin' Sticks scores showed a significant increase over 12 months (p < .001) compared to baseline. The results were unaffected by concomitant diseases, number of previous surgeries, and adherence to topical steroids, except for minor differences in rapidity of action. An excellent-moderate response was observed in 96.9% of patients at 12 months based on EPOS 2020 criteria. Conclusions Our findings from this large-scale real-life study support the effectiveness of dupilumab as an add-on therapy in patients with severe uncontrolled CRSwNP in reducing polyp size and improving the quality of life, severity of symptoms, nasal congestion, and smell

COVID-19 atypical Parsonage-Turner syndrome: a case report

Background Neurological manifestations of Sars-CoV-2 infection have been described since March 2020 and include both central and peripheral nervous system manifestations. Neurological symptoms, such as headache or persistent loss of smell and taste, have also been documented in COVID-19 long-haulers. Moreover, long lasting fatigue, mild cognitive impairment and sleep disorders appear to be frequent long term neurological manifestations after hospitalization due to COVID-19. Less is known in relation to peripheral nerve injury related to Sars-CoV-2 infection. Case presentation We report the case of a 47-year-old female presenting with a unilateral chest pain radiating to the left arm lasting for more than two months after recovery from Sars-CoV-2 infection. After referral to our post-acute outpatient service for COVID-19 long haulers, she was diagnosed with a unilateral, atypical, pure sensory brachial plexus neuritis potentially related to COVID-19, which occurred during the acute phase of a mild Sars-CoV-2 infection and persisted for months after resolution of the infection. Conclusions We presented a case of atypical Parsonage-Turner syndrome potentially triggered by Sars-CoV-2 infection, with symptoms and repercussion lasting after viral clearance. A direct involvement of the virus remains uncertain, and the physiopathology is unclear. The treatment of COVID-19 and its long-term consequences represents a relatively new challenge for clinicians and health care providers. A multidisciplinary approach to following-up COVID-19 survivors is strongly advised

Causal inference in environmental epidemiology: the role of implicit values

First published: 23 February 1999The current epistemologic debate in epidemiology has underlined the relevance of subjective judgment in the production and evaluation of epidemiologic evidence. The definition of criteria aimed at evaluating causal links requires the adoption of judgment, values and extra-scientific considerations, such as the inclusion of a precautionary principle. The purpose of the present analysis is to examine the influence of moral principles in the process of evaluating scientific data relevant to human health. Two case studies are discussed. The first one deals with the carcinogenic risk associated with occupational exposure to non-arsenical insecticides; the second one deals with the association between urban air pollution, mortality and asthmatic attacks

Causal inference in environmental epidemiology : the role of implicit values

First published: 23 February 1999The current epistemologic debate in epidemiology has underlined the relevance of subjective judgment in the production and evaluation of epidemiologic evidence. The definition of criteria aimed at evaluating causal links requires the adoption of judgment, values and extra-scientific considerations, such as the inclusion of a precautionary principle. The purpose of the present analysis is to examine the influence of moral principles in the process of evaluating scientific data relevant to human health. Two case studies are discussed. The first one deals with the carcinogenic risk associated with occupational exposure to non-arsenical insecticides; the second one deals with the association between urban air pollution, mortality and asthmatic attacks

Spontaneous abortion and maternal work in greenhouses

Background A positive association between maternal occupational exposure to pesticide and spontaneous abortion has been reported in some studies. Work in greenhouses may imply exposure of pregnant women to pesticides continuously and at elevated level. Methods A total of 717 women working in greenhouses provided information on 973 pregnancies, including 110 spontaneous abortions. These pregnancies were classified as exposed or not exposed according to maternal occupation, re-entry activities and application of pesticides in greenhouses during at least I month in the first trimester of pregnancy. The ORs for spontaneous abortion were estimated through a generalised estimate equations model for all orders of pregnancy together, and through a logistic regression model limited to first pregnancies. Results Increased risks of spontaneous abortion were found for maternal re-entry activities within 24 hr after pesticides were applied (all orders of pregnancy: OR 3.2, 95% CI 1.3-7.7; first pregnancies: OR 3.8, 95% CI 1.0-13.9) and for those who applied pesticides (all orders of pregnancy: OR 2.6, 95% CI 1.0-6.6; first pregnancies: OR 3.7, 95% CIO. 7-20,6) Conclusions The observed results support the hypothesis of an association between maternal work in greenhouses and spontaneous abortion. The main limitations of the study are lack of information on the specific chemicals used and the small number of pregnancies heavily exposed to pesticides

Surveillance of plant protection pesticides-related poisonings and injuries

Background Regulation 2009/1185/EU on sustainable use of pesticides requires reporting from European Member States on plant protection pesticide (PPP) poisonous exposures. These data can provide information to identify emerging problems and populations at risk, support the development of preventive and regulatory measures and evaluate their effectiveness. In Italy, a surveillance of acute PPP-related poisonings (SAPReP), based on Poison Control Centres data, has been implemented since 2001. In this contribution are presented the main characteristics of cases exposed in Italy in 2007–2012. Methods series of cases identified by the National Poison Control Centre in Milan, reviewed and classified by the Italian National Institute of Health according to standard procedures. Results In 2007–2012, SAPReP identified 2,108 cases of accidental PPP-related poisonings and injuries. Male patients were 1,442 (68%) while females were 442 (20%). Gender was unknown in 12% of cases (No. 224) Severity of poisoning was low in 84% of cases (No. 1,774), moderate in 14% (n. 305), high in 1% (n. 28). One case of death was identified. About 50% of poisonings occurred at work, in agricultural settings, and 36% at home. Some 70% of exposures occurred between May and September. Insecticides/acaricides were responsible in 42% of poisonings, fungicides/bactericides in 16%, herbicides in 15%, and soil sterilants in 13%. Five mass exposures were identified: two incidents were caused by off-site drift of metam sodium, a soil sterilant, and involved 86 and 103 by-standers, respectively; two incidents were caused by chlorpyrifos methyl, an organophosphate insecticide/ acaricide (one occurred in a hospital, 10 cases; one occurred in agricultural setting, 20 agricultural workers); one incident was caused by phenthoate and involved 40 agricultural workers Conclusions Surveillance based on data collected by Poison Control Centres provides an important tool to identify emerging problems and associated risk factors. The observations available in Italy on PPP-related poisonings and injuries suggest that greater efforts are needed to prevent these types of incidents