Haploidentical hematopoietic stem cell transplantation in children with high-risk hematologic malignancies: outcomes with two different strategies for GvHD prevention. Ex vivo T-cell depletion and post-transplant cyclophosphamide: 10 years of experience at a single center.

Forty patients with high-risk hematologic malignancies, median age 9 years, underwent haploidentical-HSCT from April 2005 to April 2015. Seventeen patients were transplanted with CD3-depleted PBSCs by negative selection (TCD group) following a reduced-intensity conditioning regimen (RIC), and 23 patients received T-cell-replete PBSCs followed by post-transplantation cyclophosphamide (PT-Cy group) after myeloablative conditioning (n=16) or RIC (n=7). Outcomes are reported for the TCD and PT-Cy recipients, respectively. Engraftment was achieved in 88% versus 100%. Median time to neutrophils>500/µL was 10 days versus 15 days. Platelets>20 000/µL occurred at a median of 16 days versus 20 days, respectively. Transplant-related mortality (TRM) was 24% versus 26% at 1 year. The cumulative incidence (CI) of grade III-IV acute GvHD was 7% versus 5%, and chronic GvHD 9% versus 53% (P=0.029). Relapse at 2 years was 31% versus 24%. Actuarial overall survival rates at 2 years were 47% versus 48%. Causes of death were infections (n=3), sinusoidal obstructive syndrome (n=4), acute GvHD (n=2) and relapse (n=9). These results indicate that haploidentical-HSCT is feasible in Uruguay. The TRM rate is of concern and should be the focus of continuing attention. Chronic GvHD risk was higher in the PT-Cy approach, so modifications are justified.

Feasibility and outcome of haploidentical SCT in pediatric high-risk hematologic malignancies and Fanconi anemia in Uruguay.

In total, 17 pediatric patients with hematologic malignancies (n=14) and Fanconi anemia (FA) (n=3) underwent haploidentical SCT with T-cell depletion. The patients were conditioned with reduced-intensity regimens, and CYA was used for GVHD prophylaxis. Successful engraftment occurred in 16 patients (94%). One patient failed to achieve a primary engraftment. Another patient rejected the first SCT after 10 weeks and had a successful second transplant. Of all engrafted patients, only one developed severe acute GVHD. Ten patients were alive at a median follow-up of 18 months (range, 5-62 months). The 5-years' OS was 53.8%. The three patients with FA are currently well with full-donor chimerism at 16, 6 and 5 months post transplant, respectively. The OS of 14 patients with high-risk hematologic malignancies was 47.6%. Three patients died as a result of post transplant leukemia relapse. CMV infection, GVHD and organ injury were other causes of mortality. Haploidentical SCT was found to be an alternative feasible treatment in Uruguay for patients who need allogenic transplantation but lack an HLA-identical family donor. It should be considered as an early option in FA patients before transformation or significant exposure to blood products.

Manejo odontológico de paciente con déficit de factor XII: reporte de un caso

El Servicio de Medicina Transfusional del Centro Hospitalario Pereira Rossell es el centro de referencia nacional en el área materno infantil. En el marco del convenio MSP- Facultad de Odontología de la UDELAR, se atienden en este Servicio pacientes con diversas coagulopatías. El déficit de factor XII es una patología de baja prevalencia (1-1000000) y no existe evidenciacientífica que respalde protocolos clínicos de atención a nivel odontológico. Se presenta el caso clínico del paciente NT, portador de esta patología, de alto riesgo con alta actividad de caries, en dentición mixta, a quiense le realizó tratamiento odontológico integral con apoyo del equipo multidisciplinario que trabaja en el Servicio de Hemoterapia del CHPR. (AU) FON

Environmental car exhaust pollution damages human sperm chromatin and DNA.

OBJECTIVE: The adverse role of traffic pollutants on male fertility is well known. Aim of this study was to evaluate their effects on sperm chromatin/DNA integrity. METHODS: To accomplish this, 36 men working at motorway tollgates and 32 unexposed healthy men (controls) were enrolled. All of them were interviewed about their lifestyle. Hormone, semen samples, and environmental and biological markers of pollution were evaluated. Sperm chromatin and DNA integrity were evaluated by flow cytometry following propidium iodide staining and TUNEL assay, respectively. RESULTS: LH, FSH, and testosterone serum levels were within the normal range in tollgate workers. Sperm concentration, total sperm count, total and progressive motility, and normal forms were significantly lower in these men compared with controls. Motorway tollgate workers had a significantly higher percentage of spermatozoa with damaged chromatin and DNA fragmentation, a late sign of apoptosis, compared with controls. A significant direct correlation was found between spermatozoa with damaged chromatin or fragmented DNA and the length of occupational exposure, suggesting a time-dependent relationship. CONCLUSION: This study showed that car exhaust exposure has a genotoxic effect on human spermatozoa. This may be of relevant importance not only for the reproductive performance of the men exposed, but also for the offspring health.

[Respiratory function evaluation in welders taking into account tecnological evolution of individual protection dispositive and risk specific information]. / Valutazione dei parametri di funzionalità respiratoria nelle attività di saldatura alla luce della evoluzione tecnologica dei DPI e di programmi di informazione e formazione mirati.

Aim of the study is to evaluate the effect of specific information program on DPI use on the functional respiratory parameters in a group of 15 welders compared with 18 welders not included in the program and 18 workers of industrial sector. Spirometryc parameters were recorded and compared and the results pointed out a significant increase of FEV1 and FVC in the study group compared with welder out of the study while no difference were observed between study group and workers of industrial sector. Results shown that the correct use of DPI could reduce the effects of welding fumes on respiratory tract making these effects equal to the exposure to industrial dusts.

Effects of working posture and exposure to traffic pollutants on sperm quality.

An increasing difficulty of couples in achieving pregnancy related to male infertility has been reported. Several factors have been implicated as possible causes of this decrease, including the exposure to the endocrine disruptors and the environmental toxicants, the changes in lifestyle and the exposure to heat. The aim of this study was to evaluate the role of working posture when associated to nitrogen oxides exposure. Three hundred and seven male workers, employed in a motorway company, were enrolled into the study, underwent a complete physical examination and laboratory evaluations, endocrine screening and sperm analysis. Taking into account the exposure to fuel combustion gases and the working posture, sitting or free, the study population was divided in 4 groups. In the subjects occupationally exposed to NO2, a significant lower sperm total motility was observed than in not exposed workers. In the workers with obliged sitting working posture, lower sperm motility was also observed than in the workers with free working posture. Differences in sperm quality were strong when chemical and postural risk factors were associated. The findings of this study confirmed detrimental effects of nitrogen dioxide as a marker of traffic pollutants, showing alterations of sperm quality even if the environmental concentration of gas is very low according to the limits established by the Italian legislation. They suggest, also, the possible interaction between chemical exposure and obliged sitting position.

[Smoking habit among workers in Campania region]. / L'abitudine al fumo nei lavoratori Campani.

Smoking is still now the main avoidable cause of disease, disability and mortality in industrialized countries. This habit is still very common in workplaces, where anti-smoke efforts seem to be less incisive than among general populations. The study analyzed the diffusion of smoke habit in 8111 male workers in Campania region, employed in different work activities (white collars, blue collars, drivers, cleaning civil servants, porters), so as to evaluate work related features, affecting its assumption and maintenance. Among all workers, smokers prevalence (42.7%) was higher than national male population. Percentages of smokers were highest among drivers (60.7%) and civil servants (52.5%), slightly lower among industry workers (47.3%) and lower among white collars (36.4%). The highest prevalence were found in 41-50 years age group (46.8%), but only among white collars aging was associated with higher smokers prevalence. Lower education degrees and two working variables, shifts and handwork, have been related with significantly smoking habit assumption. Results emphasized that health promotional programs are necessary to reduce smoke habit among workers, particularly among professionally and culturally unqualified subgroups.

[Chronic-degenerative diseases in health care activities: data from health surveillance of Federico II University General Hospital in Naples]. / Patologie cronico-degenerative nelle attività assistenziali: i dati nell'Azienda Ospedaliera Universitaria Federico II di Napoli.

Recent average life increase, as well as new habits and lifestyles assumption, has determined a change in population health profiles, as a result of progressive increase in chronic-degenerative diseases prevalence. Among these latter; musculoskeletal and cardiovascular diseases are the most frequent ones. Health care workers also suffered from this change in health profiles. This study, performed thanks to the extension of Health Surveillance to all health care workers, aimed at evaluating chronic-degenerative diseases risk among three main welfare activities (medical, nursing and auxiliary). In conclusion, data showed that nurses, mainly the shift workers, are exposed to a higher risk of chronic-degenerative diseases. All other health care workers have not significant work risk factors, because of a greater burden of aging and lifestyles effects.

[Subjective perception of maladjustment risk factors]. / La percezione soggettiva dei fattori disadattanti al lavoro.

Maladjustment at work results from organizational and relational features of the work, the so-called fourth type factors; they include working hours, ways and contents of working activities, and horizontal and vertical business relations. The study reports the percentage of sensed disturbing factors in workers with maladjustment and disaffection at work. Data have been taken from 1382 white collars, 1117 males and 265 females, observed from January 2006 to June 2007 for Health Surveillance. Maladjustment prevalence was higher in females than in males. As individual variables, ageing and family care increased the prevalence of maladjustment among females, whilst a higher prevalence of maladjustment were found in youngest and unmarried males. A very different perception of work harmfulness were found between sexes. As risk factors, female have denounced more wear and tear and authoritarian management; male denounced physical strain.

[Burden of COPD on health profiles in different work activities]. / La broncopatia cronico-ostruttiva nella popolazione generale e in popolazioni lavorative.

According to WHO, COPD will be the 5th cause of disability and the 3rd cause of mortality by 2020. Even cigarette smoking represents the main cause of COPD recent studies demonstrated positive association with occupational exposure. In Europe costs of COPD were estimated at about 38,8 billion Euros in 2000; its burden is also expected to increase. Aim of the study is to evaluate the burden of COPD on health profiles in a sample of workers of Campania region. Prevalences were calculated in a sample of 908 male workers, employed in industrial (479) and tertiary (429) sectors. Results were compared with population data of ISTAT database. Higher prevalence of COPD was found in industrial workers (23.4%) than general population (3.5%) and tertiary workers (2.1%). Analysing smoking habits, higher prevalence of smokers in the industrial sector (75.9%) than tertiary (66.4%) was found, but this difference cannot explain the big difference of COPD prevalence between the two groups and suggest a positive interaction between smoking and occupational exposure. In conclusion, the results analysis underlines the burden of COPD on workers' health status, particularly in some work activities. Specific health promotion programs are necessary in these activities.

[Not allergic dermatitis as occupational diseases: a suggestion for an evaluation method]. / La definizione della professionalità delle dermatiti non allergiche: proposta di un metodo di valutazione.

Aim of the study was to propose a method to define the relationship of not allergic contact dermatitis with chemical risk factors in workplace. This method evaluates the skin response to simultaneous chemical and mechanical stimulation, made with a soft bristle brush. The method has been used on 9 cases of not allergic skin diseases, observed from 2000 to 2006 in Occupational Medicine Division of "Federico II" University of Naples. The greatest part of pathologies had the polymorphous pattern of skin inflammation, characterized by subintrant erythema, suspected of occupational origin. In 6 cases a stronger reaction to both chemical and mechanical stimulation was highlighted, confirming a possible occupational etiology. In 1 case the occupational origin was excluded, while in 2 cases the skin response was uncertain. The method does not define all cases of occupational skin pathologies, but it seems to be very useful to diagnostic and insurance needs.