[The evaluation of workplace visual characteristics and ophthalmologic requirements to define fitness to work]. / Valutazione delle esigenze visive del posto di lavoro e requisiti oftalmologici per l'idoneità alla mansione specifica.

It's necessary to proceed to an evaluation of visual function to define principal ophthalmologic requirements and fitness to work in relation of workplace characteristics. We also have to consider the effects of age on visual function, the specific work risks on eyes and sight care especially for near sight. The evaluation of these parameters permits to verify the compatibility between the psychophysics characteristics of workers and the requests of tasks and then to define fitness to its work. Moreover to the visual functions we have to consider organic visual conditions like conjunctivitis, blepharitis, stenosis of lacrimal gland, dacriocystitis, retinic diseases, muscular motility alteration of the eyes, glaucoma. Our study shows the relation between ophthalmologic requirements of workers and some job groups like professional drivers, technical clerks, precision work, height level workers and proposes a standard method to define fitness to work. Our standard method permits a specific and homogeneous evaluation of fitness to work.

[Application of a protocol for assessing occupational fitness of workers with UE-WMSDS in a second-level hospital center: first results]. / Applicazione di un protocollo di valutazione dell'idoneità lavorativa di soggetti affetti da UE-WMSDS in un centro ospedaliero di secondo livello: primi risultati.

It's presented a cluster of 99 workers affected by UEWMSDs examinated in the Occupational Medicine Department--University of Turin. The object of the evaluation is the critical exam of ergonomic informations, the evalution of the fitness to work and the customed return to work.

One-year surveillance of legionellosis in burned patients and Legionella environmental monitoring.

Burned patients have a theoretically high risk of Legionella infection because burns produce a compromised immune system. Cutaneous surfaces are without protective barriers, and bathing tank water is frequently used for washing and caring. A one-year surveillance study was performed on 65 burned patients by antibody determination and by culture of bronchial aspirates. Environmental culturing for Legionella was done in the patients' care areas every four months during the same period. Low titers ranging from 8 to 32 were found in 30 (46.1%) subjects against 18 antigens including several Legionella species. No increase in antibody titers was shown in 193 patients' sera. Cultures of respiratory samples were negative. L. pneumophila serogroups 4, 5, 6 and 8 and L. rubrilucens were isolated from 55.5% of water samples. Despite no evidence of Legionella infection among patients included in this study, the authors believe it to be advisable to improve control measures in hospital water supplies, used by burned patients, to minimise the risk of legionellosis.

Microbiological investigations on a nosocomial case of Legionella pneumophila pneumonia associated with water birth and review of neonatal cases.

A case of Legionella pneumophila 1 pneumonia, confirmed by positive serology and urinary antigen, occurred in a 7-day old neonate after water birth in hospital. As respiratory samples were not available for culture, further microbiological investigations were performed in neonate and environment, in order to recognize the source of infection. The hospital water supply was contaminated by L. pneumophila 1 strains (300-2000 cfu/L) of two monoclonal subtypes of Pontiac subgroup. L. spiritensis (10-225 cfu/L) was isolated from cold tap water of the patient's home. PCR from tap and humidifiers water of the patient's home was positive for Legionella spp, but not for L. pneumophila. Because L. pneumophila 1, responsible of child infection, was only isolated from the hospital pool water for waterbirthing, we conclude that the infant acquired the nosocomial legionellosis by prolonged delivery in contaminated water, perhaps by aspiration. Infection control measures for waterbirthing are highly recommended. A review of neonatal case of legionellosis is also presented. As this rare infection may have a high fatality rate if unrecognized, pediatricians should be aware of the possibility of the legionellosis in newborns.

Culture proven Legionella pneumophila pneumonia in a HIV-infected patient: case report and review.

We report the first culture proven case of Legionella pneumonia in a HIV-positive patient in Italy. The laboratory diagnosis was obtained by isolation of Legionella pneumophila serogroup 1, serology, urinary antigen detection and PCR. Culture first allowed diagnosis of the infection, that probably would have been unrecognized. Since Legionellosis in HIV-positive patients with respiratory symptoms is rare and difficult to confirm, we strongly suggest that all available laboratory tests, and particularly culture, should be performed. A review of literature on culture proven cases is also provided.

Evaluation of the efficacy of ultraviolet irradiation for disinfection of hospital water contaminated by Legionella.

We evaluated the efficacy of the ultraviolet irradiation on hospital water colonized by Legionella pneumophila serogroup 3, by inserting a lamp system on a hot water pipe supplying a small area. Cultures were performed for four months from 5L samples of water, collected before and after the ultraviolet treatment at the lamp unit and from two distal points. Irradiation was effective immediately after disinfection (<10 cfu/L), even when the incoming water was highly contaminated. One distal point showed little or no contamination (<10-20 cfu/L), while the other showed little to moderate contamination (<10(3) cfu/L). We conclude that ultraviolet irradiation is useful to protect the water system in small area; however, because of the lack of residual activity, it should be combined with other methods of disinfection. Maintenance of the water system is also necessary in order to reduce biofilm formation and Legionella recolonization.

Legionella pneumophila pneumonia in a newborn after water birth: a new mode of transmission.

We report a case of Legionella pneumophila pneumonia in a 7-day old neonate. Because the hospital water, and particularly the pool water for water birthing, was contaminated by L. pneumophila serogroup 1, the newborn was infected following prolonged delivery in contaminated water, perhaps by aspiration. This is the first case of nosocomial Legionella pneumonia in neonate after water birth.

Comparative evaluation of two commercially available antigen enzyme immunoassays (EIA) for the detection of Legionella pneumophila urinary antigen in frozen non-concentrated urine samples.

We evaluated two commercial enzyme immunoassay kits, Binax EIA (for detection of soluble antigen of Legionella pneumophila serogroup 1) and Biotest EIA (for detection of antigens of Legionella pneumophila serogroups and other Legionella spp.) in order to introduce this test routinely for the diagnosis of Legionnaires' disease (LD) in our Laboratory. Frozen non-concentrated urine samples belonging to 45 patients with and without LD were tested. The sensitivity of Binax EIA and Biotest EIA was 47.4% and 42.1% respectively, the specificity was 95% by both tests. Biotest did not detect antigen from a patient with culture-proven infection of L. pneumophila serogroup 6. The detection of urinary antigen by both EIA tests is a useful tool for rapid diagnosis of LD, especially when samples are unavailable for culture; the sensitivity may be increased if the assay is performed on unfrozen and concentrated samples.

Clarithromycin and amoxicillin susceptibility of Helicobacter pylori strains isolated from adult patients with gastric or duodenal ulcer in Italy.

Helicobacter pylori strains, isolated from 100 gastric biopsies from 49 previously untreated adult patients with endoscopy and histology-confirmed gastric or duodenal ulcer, were tested for in vitro antimicrobial susceptibility. Strains were isolated from biopsies of 75.5% (37 of 49) patients before therapy and of 13.5% after therapy. Clarithromycin and amoxicillin susceptibility testing was performed on pretreatment and posttreatment strains by using the agar disk diffusion method and E-test, a quantitative technique for the minimal inhibitory concentration (MIC) determination. All strains (n = 53) were susceptible to amoxicillin by the two methods. Three strains of 34 (8.8%) patients were resistant to clarithromycin: two by both methods and one by E-test (MIC > 2 microg/ml). E-test, although more expensive than the disk diffusion method, is easy to perform and is a reliable method for testing H. pylori susceptibility to antimicrobial agents in the clinical microbiology laboratory.