Neural correlates of fatigue in multiple sclerosis: a combined neurophysiological and neuroimaging approach (R1).

The present study is aimed at further exploring structural and functional correlates of fatigue in Relapsing- Remitting Multiple Sclerosis (RRMS) patients by using a combined approach by means of transcranial magnetic stimulation (TMS) and a Diffusion Tensor Imaging (DTI). The physiopathology of fatigue in MS is still poorly understood, although a variety of pathogenic mechanisms has been proposed. Our working hypothesis is that diffuse microstructural white matter damage may subtend the cortico-subcortical functional disconnection described in patients with MS and fatigue. We enrolled 30 RRMS patients (mean age 39±13; age range 24-63 years) with mild neurological impairment Expanded Disability Status Scale <3.5, divided into two groups on the basis of their fatigue severity scale (FSS) scoring (cutoff ≥ 4). All the patients underwent a neurological evaluation, a brain MRI acquisition (including DTI study) and a neurophysiological assessment by means of TMS in a pre-movement facilitation paradigm. Our data showed a significant mean diffusivity (MD) increase (p=0.036) in left thalamo-frontal reconstructions in the MS patients with fatigue compared to those classified as non-fatigued. Moreover, significant correlations were observed between FSS scale and MD as well as planar coefficient (CP) values extracted from frontal-thalamic connections bilaterally. Instead, the pre-movement facilitation showed a significant difference between the groups with particular regard to the Reaction Time- MEP50ms amplitude (p=0.03). Our work confirms that fatigue is associated with a disruption of brain networks involved in motor preparation processes, depending on several frontal-thalamic pathways. Such findings can have an important role when dealing with fatigue management in MS patients and could be eventually used as prognostic marker of MS course.

[Assessment of occupational stress among shopping centre employees]. / Valutazione dello stress lavoro correlato nei lavoratori di un centro commerciale.

Occupational stress literature emphasizes the importance of assessment and management of work related stress. The recognition of the harmful physical and psychological effects of occupational stress on both individuals and organizations is widely studied in Europe. In Italy such legislation was introduced by Legislative Decree 81/2008. Objective of the present study was to evaluate the occupational stress level of a shopping centre employees. A sample of 50 workers, 54% male (n = 27) and 46% female (n = 23) underwent to the Occupational Stress Index (OSI) questionnaire, used to examine occupational stress level of employees through the evaluation of work organization, individual characteristics, coping strategies, and psychosomatic effects of the stress. The results of OS were compared to the stress levels of a reference population. Results of data analysis provided evidence that the work organization of the examined shopping centre was good and there was no correlation between work characteristics, personality patterns, coping strategies and the psychosomatic effects of the stress. In addition a negative relationship between job satisfaction and length of service was found. Improvements in working conditions as well as early diagnosis are essential for preventing further increases in these disorders among workers. The next step would be multidisciplinary intervention studies aimed at the work environment, with the goal of identifying scientifically-based strategies that are most effective in preventing occupational stress.

Meibomian gland dysfunction and ocular discomfort in video display terminal workers.

PURPOSE: Meibomian gland dysfunction (MGD) is one of the most common ocular disorders encountered in clinical practice. The clinical manifestations of MGD are related to the changes in the tear film and ocular surface with symptoms of ocular discomfort. In recent years, many surveys have evaluated symptoms associated with the use of Video Display Terminals (VDT), and VDT use is recognized as a risk factor for eye discomfort. The aim of the present study was to determine if the presence of MGD contributes to the signs and symptoms of ocular discomfort during the use of VDT. METHODS: In course of a routine health surveillance programme, a group of 70 subjects fulfilled the inclusion criteria and responded to a questionnaire about symptoms of ocular discomfort. The following ocular tests were performed: tear break-up time, fluorescein corneal stain, and basal tear secretion test. RESULTS: A total of 52 subjects out of 70 (74.3%) had MGD. A statistically significant correlation between the symptoms of ocular discomfort and hours spent on VDT work was observed in the total population (r=0.358; P=0.002; 95% CI 0.13-0.54) and in the group of subjects with MGD (r=0.365; P=0.009; 95% CI 0.103-0.58). Such correlation was not shown in subjects without MGD. CONCLUSIONS: The high prevalence of MGD among the subjects with symptoms of ocular discomfort suggests that this diagnosis should be considered when occupational health practitioners encounter ocular complaints among VDT operators. It appears that MGD can contribute to the development of ocular discomfort in VDT operators.

[Asthenopia in VDT users: our experience]. / Astenopia e lavoro al VDT: nostra esperienza.

The aim of this study was to investigate the relationship between asthenopia and work with video display terminals (VDT). 62 office workers (29 males and 33 females), that use VDT for more than 20 hours each week, were investigated by means of standardized questionnaires (elaborated by the Italian Society of Occupational Medicine and Industrial Hygiene). The authors analyzed the prevalence of occupational asthenopia and its correlation with the duration of weekly VDT use and the presence of refractive alterations. It was demonstrated a prevalence of asthenopia of 51% and a statistically significant correlation between the entity of asthenopic symptoms and number of weekly hours and years of work at VDT, in particular in subjects with presbyopia.

[Hand-arm vibration syndrome and upper limbs diseases in the forest workers of Italia meridionale]. / Sindrome da vibrazioni mano-braccio e patologie degli arti superiori in lavoratori forestali dell'Italia meridionale.

Vibration exposure of the hand-arm system is associated with an increased risk of upper-limb vascular, neurological and musculoskeletal lesions, or hand-arm vibration syndrome (HAVS). The prevalence of occupational HAVS and upper-limb disorders was studied among 278 Forestry Service workers in Sicily and Calabria. Subjects who used chain-saws (18 weeks/year) had a greater prevalence of peripheral sensory-neural disturbances (28%), upper-limb musculoskeletal disorders (33%) and carpal tunnel syndrome (19%) compared with 260 manual workers from the same Corps not exposed to hand-transmitted vibration. Raynaud's phenomenon was comparable in exposed and control subjects (5.3% vs. 4.7%.) Upper-limb neuropathies were significantly associated with energy-equivalent frequency-weighted acceleration; exposure duration; and cumulative vibration dose (m2/s4h). The variable "years of work with vibrating tools" was strongly associated with peripheral neuropathies; carpal tunnel syndrome; and upper-limb musculotendinous syndromes. Data suggest that in Sicily and Calabria, where the climate is milder than in other areas of Italy, forestry work with hand-held vibrating tools does not entail a greater prevalence of peripheral vascular disorders (Raynaud's phenomenon), while the prevalence of occupational upper-limb neurological and musculoskeletal disorders, in which combined ergonomic and mechanical risk factors have a large pathogenic role, is significantly increased.

[Air pollution in urban areas as a risk factor for health in the general population and in workers. Environmental and biologic monitoring of 1-3 butadiene]. / L'inquinamento atmosferico delle aree urbane come fattore di rischio per la salute della popolazione generale e lavorativa. monitoraggio ambientale biologico dell'1-3 butadiene.

Exposure to 1,3-butadiene (BD), a probable carcinogen to humans, was investigated in two groups of subjects working in a refinery plant: 28 occupationally exposed workers and 21 subjects non-occupationally exposed controls. BD in blood was higher in the exposed workers than in controls. Excretion of urinary mercapturic acids N-acetyl-S-(3,4-hydroxybutyl)-l-cysteine (MI), was not influenced by occupational exposure. The present study shows that unmetabolised BD in biological fluids, represents the biomarker of choice for assessing occupational exposure to low airborne concentrations of BD.

[Influence of microclimate factors on ocular discomfort in video display terminal workers]. / Influenza dei fattori microclimatici sul discomfort oculare in lavoratori addetti al VDT.

The objective of the present research was to evaluate the effect of environmental parameters (temperature, air velocity, relative humidity, illumination level, cubature) on ocular symptoms (tiredness, tearing, redness, blinking, itching, burning, photophobia, foreign body sensation, and heaviness) in a group of 54 male Video Display Terminal (VDT) workers. The subjects were employed in a public office placed in Messina and naturally ventilated; the investigation was performed in Spring time. Information about the ocular symptoms, occurring during the workshift, were gathered through a questionnaire; environmental measurements were performed by a data collector LSI. The results showed that 43 subjects out of 54 (79%) reported a lack of eye comfort; in addition the illumination level, temperature and air velocity were not consistent with those suggested by the Italian Regulatory Authority. A significant correlation between illumination level, temperature, air velocity and eye discomfort (tearing, heaviness, blinking, photophobia itching, respectively) was found. The Authors conclude that the inadequate environmental condition, possibility in interaction with the indoor chemical contaminants and the workload at VDT, may be responsible for the irritative eye symptoms complained by VDT-workers at workplace.

Stressful life events and fibrinogen level in middle-aged teachers.

BACKGROUND: Strong evidence has been reported that a high plasmatic level of fibrinogen plays a central role in the development of coronary heart disease. Many researches showed that stressful life events lead to an increase in plasmatic fibrinogen. The present investigation examined the relationship between plasmatic fibrinogen level and stressful life events. SAMPLING AND METHODS: A sample of 40 middle-aged women employed as teachers underwent a general objective examination, a venous puncture for plasma fibrinogen level evaluation, and completed a questionnaire regarding health behaviours, at baseline and 1-year follow-up. The stressful life events were recorded using the Paykel's interview for recent life events. RESULTS: At the baseline assessment, the distribution of teachers in the two stress exposure groups was 16 women for the non-exposed group of teachers, and 24 for the exposed teachers, while at the 1-year follow-up assessment, it was 10 for the non-exposed and 30 for the exposed group. The number of teachers exposed to stress was significantly higher at the 1-year follow-up than at the baseline assessment (30 and 24, respectively; p < 0.05). Average levels of plasmatic fibrinogen were significantly higher in stress-exposed women than in non-exposed women both at baseline assessment (p < 0.01) and at 1-year follow-up (p < 0.002). Moreover, the mean value of fibrinogen at the follow-up assessment showed a higher increase in stressed women compared with non-stressed women with an annual increase of 10.71 and 5.40%, respectively. CONCLUSIONS: Stress may trigger the hypercoagulable state evidenced by an increased plasmatic fibrinogen level. This mechanism may help explain the adverse impact of stress on the cardiovascular system.

Mini-invasive management of a rare complication of percutaneous stone treatment: entrapped nephrostomy tube.

A case of entrapped nephrostomy tube in a 61-year-old woman who underwent percutaneous nephrolithotomy and subsequent multiple ESWL for a left staghorn stone is presented. A nephrostomy track was created alongside the Malecot catheter and the overgrown tissue which was bridging the wings of the tube was incised with a Sachse urethrotome. To prevent this complication the wings of the Malecot should freely expand in the renal collecting system and the catheter should stay in situ for no more than 3 weeks.

[Work and video terminals: eye discomfort and blepharitis. Preliminary data]. / Lavoro al videoterminale: discomfort oculare e blefariti. Dati preliminari.

Blefaritis is one of the most common ocular disorders encountered in clinical practice. The clinical manifestation primarily occurs along the lid margin, and the predominant symptoms are itching and burning. In addition, the inflammation could cause a dysfunction of meibomian gland; this condition leads to ocular surface abnormalities. Objective of the present study was to determine if the Visual Display Terminals (VDT) work get worse the signs and symptoms of blefaritis in a group of 35 VDT operators. Results showed a correlation between burning, itching and corneal fluorescein staining and hour number a day of VDT work in the workers affected by blefaritis. The Authors concluded that VDT work can get worse the signs and symptoms of blefaritis.

[Cognitive sequelae of acute hydrogen sulphide poisoning. A case report]. / Sequele cognitive nell'intossicazione acuta da idrogeno solforato. Descrizione di un caso clinico.

BACKGROUND: Hydrogen Sulphide (H2S) is a highly toxic, colorless gas smelling of rotten eggs. It is used in several industries and is a product of many industrial processes such as oil refining, mining and rayon manufacture. Acute, non fatal H2S intoxication at a concentration of 500 ppm, for few minutes, is followed by brain damage characterised by both immediate and permanent neurobehavioural deficits. OBJECTIVES: The present study describes the neurobehavioral effects of acute, non-fatal H2S intoxication in a healthy 36-year-old male at the workplace. METHODS: Three months after the acute poisoning, the subject was examined via a neurological examination, neuropsychological tests (Mini Mental State, Verbal Span Test, Digit Span Test, Bourdon-Wiersma Dot Cancellation Test, Benton Visual Retention Test, Somatognosia, Simple Visual Reaction Time, Simple Acoustic Reaction Time), Nuclear Magnetic Resonance (NMR), and Single Photon Emission Tomography (SPET). RESULTS: The results showed a reduction of cognitive capabilities, depressive symptoms and personality changes even through the results of neurological examination and neuroimaging techniques were unremarkable. CONCLUSIONS: Neuropsychological testing is a key issue in neurotoxicology assessment, because conventional neurology has been shown to be insensitive to the chemical neurotoxic effects and neuroimaging techniques are often unclear.

Bone alterations in patients with idiopathic hypercalciuria and calcium nephrolithiasis.

OBJECTIVES: To verify whether alterations in bone density and turnover in patients with calcium nephrolithiasis and hypercalciuria are observable in various subgroups of patients divided according to the pathogenesis of the hypercalciuria. METHODS: Seventy patients with calcium nephrolithiasis and idiopathic hypercalciuria, 19 to 64 years old, were assessed for spine and femur mineral metabolism and bone density using a Dexa evaluation system. After a low calcium diet, the subjects were classified into two groups: fasting hypercalciuria (FH, 39 patients) and absorptive hypercalciuria (AH, 31 patients). RESULTS: Only in the patients with FH was the lumbar spine bone density lower than in the controls (P <0.001). Also, only the patients with FH had higher bone alkaline phosphatase and urinary hydroxyproline levels than the control group (P <0.005 and <0.015, respectively). The blood pH levels were lower, even though within the normal range, in the hypercalciuric patients than in the controls (P <0.01). There was a negative correlation between the urinary hydroxyproline level and lumbar spine and femoral neck density in patients with FH (P <0.001 and <0.005, respectively), and the blood pH correlated positively with the lumbar spine bone density. CONCLUSIONS: Altered bone metabolism and overall bone loss were found only in the patients with FH. Overloading of acid valences, perhaps of dietary origin, could be the pathogenic factor responsible.

Ocular discomfort and conjunctival alterations in operating room workers. A single-institution pilot study.

OBJECTIVES: The aim of this pilot study was to relate the eye symptoms complained of by subjects working in the operating rooms of a hospital in southern Italy, with the observations of alterations of the ocular surface. METHODS: An epidemiological study was carried out by a questionnaire aimed at investigating the prevalence of ocular discomfort symptoms among 213 subjects working in operating rooms and 40 subjects working in the wards. The investigated symptoms were the following: tiredness, heaviness, burning, redness, tearing, itching, blinking, foreign body sensation, and photophobia. A randomised comparative study of the ocular surface and conjunctival cytology was also carried out, comparing two groups of age- and gender-matched subjects. Group 1 included 24 subjects randomly chosen from the operating room workers with ocular discomfort symptoms; group 2 included ten subjects randomly enrolled from hospital personnel working in the wards. Ophthalmological examination of the ocular surface was performed on each subject in the following order: slit-lamp examination, break-up time (BUT) of the pre-corneal tear film, corneal fluorescein stain, lachrymal basal secretion test, conjunctival impression cytology. RESULTS: A high prevalence (72.3%) of ocular discomfort symptoms was reported by operating room workers, while in ward personnel the prevalence was 55% (P = 0.04). The ocular tests showed that the conjunctival features and BUT were statistically significantly altered in subjects in group 1. Also, the conjunctival impression cytology study showed statistically significant alterations of all the investigated parameters: specimen cellularity, cell-to-cell contacts, nucleus/cytoplasm ratio, chromatin pattern, goblet cell distribution, keratinisation and the total cytological score. CONCLUSIONS: Our results show that self-reported eye complaints and ocular surface alterations have a high prevalence in subjects working in the operating rooms. This seems to indicate that the operating room environment could play a role in the onset of the eye disturbances.

Bulbar urethral stricture repair with buccal mucosa graft urethroplasty.

OBJECTIVES: Evaluation of the use of buccal mucosa graft as single-stage urethral reconstruction in an adult population with a stenosis of the bulbar urethra. METHODS: In our Department between April 1996 and February 1999, 20 patients with bulbar urethra stenosis underwent single-stage urethroplasty using a buccal mucosa graft. Mean age of patients was 52 years (range 14-70). The etiology of urethral stricture was inflammation (4 cases), iatrogenic (5 cases) and idiopathic (11 cases). A ventral onlay patch (mean length 3.6 cm, range 2.5-5) was employed in all cases. RESULTS: During the follow-up (median 13 months, range 6-28) the overall success rate was 80%. The success rate was 75% for inflammatory strictures, 80% for iatrogenic strictures and 81% for strictures of unknown etiology. CONCLUSIONS: Although longer follow-up is needed, free graft urethroplasty with buccal mucosa graft represents a simple surgical option which has produced encouraging results. This is probably due to the quality of the tissue employed which at present seems to represent the first-choice solution in selected cases.

[Retrospective study on the prevalence of latex allergic pathology in health personnel]. / Studio retrospecttivo sulla prevalenza di patologia allergica da latice negli operatori sanitari.

To evaluate the prevalence of latex sensitisation and latex-related symptoms, we performed a study on 837 hospital employees. All subjects were asked for medical and occupational history, and underwent Skin Prick Test (SPT) with latex and other airborne allergens. The results showed a prevalence of latex sensitisation of 6.1% and a prevalence of symptoms of 5.26%. The most frequent symptoms were oculorhinitis, dermatitis and asthma. The one-year retrospective evaluation showed, in a group of 767 hospital attendants selected by the whole population, an incidence of sensitisation of 0.26%; no new cases of latex-related symptomatology were observed. The improvement of symptoms was due to the reduction of the exposure to latex gloves. The results of the study confirm the importance of prevention strategies.

[Symptoms of ocular discomfort and microclimate: epidemiologic and environmental survey in operating rooms]. / Sintomi da discomfort oculare e microclima: indagine epidemiologica e ambientale nelle sale operatorie.

An epidemiological investigation regarding the ocular symptoms of 213 subjects working in the operating theatres of a hospital of the eastern Sicily was conducted. Information was gathered via a questionnaire designed to identify the ocular symptoms that occurred most frequently during working hours in the operating theatre. The questionnaire was administered by a specialist in Occupational Health, before any decision was made to investigate the indoor air quality. The microclimate parameters (temperature, relative humidity, number of air changes/hour, air velocity, illumination levels) of the operating theatres were also studied. The results of the epidemiological investigation showed that 154 subjects out of 213 (72.3%) reported a lack of eye comfort. The most frequently reported symptoms were fatigue (35.21%) and heaviness (34.27%), followed by burning (25.82%), redness (25.35%), lacrimation (17.84%), itching (2%), blinking (20%), foreign body sensation (19%) and photophobia (10%). The study of the indoor climate of the operating theatres showed that the number of air changes/hour and illumination level were not consistent with those recommended by the Italian Regulatory Authority. Others parameters were considered to be satisfactory. The Authors conclude that the low illumination level may be responsible for the high percentage of subjects suffering from eye fatigue and heaviness. The ineffective rate of room air exchange, possibly interacting with chemicals and aerosols, is thought to be responsible for the other ocular symptoms experienced by the workers. The present study suggests that the operating theatre environment might be a cause of the ocular discomfort often complained of by health care workers. Further studies are needed in this area.