Fifteen Years of Iodine Prophylaxis in Italy: Results of a Nationwide Surveillance (Period 2015-2019).

CONTEXT: In 2005, a nationwide program of iodine prophylaxis on a voluntary basis was implemented in Italy by law. However, recent data on iodine status are lacking. OBJECTIVE: The aim of this study was to evaluate efficiency, effectiveness, and possible adverse effects (increased occurrence of thyroid autoimmunity and hyperthyroidism) of the Italian iodine prophylaxis program. METHODS: From 2015 to 2019, a nationwide survey was performed. The use of iodized salt was evaluated in a sample of 164 593 adults and in 998 school canteens. A sample of 4233 schoolchildren (aged 11-13 years) was recruited to assess urinary iodine concentration, prevalence of goiter, and thyroid hypoechogenicity on ultrasound, with the latter being an indirect indicator of thyroid autoimmunity. Neonatal TSH values of 197 677 infants screened in regions representative of Northern, Central, and Southern Italy were analyzed to investigate the percentage of TSH values >5.0 mIU/L. Data on methimazole prescriptions were analyzed as indirect indicators of new cases of hyperthyroidism. RESULTS: The prevalence of the use of iodized salt was 71.5% in adult population and 78% in school canteens. A median urinary iodine concentration of 124 µg/L, a prevalence of goiter of 2.2%, and a prevalence of thyroid hypoechogenicity of 5.7% were observed in schoolchildren. The percentage of neonatal TSH values >5.0 mIU/L resulted still higher (5.1%) than the World Health Organization threshold of 3.0%, whereas the prescriptions of methimazole showed a reduction of 13.5%. CONCLUSION: Fifteen years of iodine prophylaxis have led to iodine sufficiency in Italy, although there still is concern about iodine nutritional status during pregnancy.

Preliminary Investigation on Hygienic-Sanitary Quality of Food Vending Machines.

The consumption of hot drinks dispensed from vending machines has become a common practice, both in workplaces and during free time. Every day, millions of bulk drinks are sold, but the quality of the products distributed may not always be guaranteed, as it is related to many factors such as the quality of the water, the raw materials used, and the effectiveness of the equipment's cleaning system. The purpose of this study is to evaluate the hygienic-sanitary requirements of hot drinks and vending machine surfaces. The investigation highlighted the microbial contamination of both coffee and vending machine surfaces. Although the "coffee break" is usually considered a moment of pleasure, apparently not subject to specific jurisdiction, the products dispensed can represent a health risk if the hygienic conditions are not fully respected. Therefore, official controls carried out by the Prevention Department represent a suitable way for evaluating and guaranteeing the hygienic-sanitary requirements, providing for corrective actions, when needed, to protect consumers.

Prevalence of temporomandibular disorders in adult obstructive sleep apnoea patients: A cross-sectional controlled study.

BACKGROUND: Obstructive sleep apnoea (OSA) is characterised by partial or complete obstruction of the upper airways during sleep and it has been associated with temporomandibular disorders (TMDs) on the basis of several pathophysiological hypotheses. OBJECTIVES: To assess the prevalence of TMDs in a population of patients affected by OSA compared to a control group of subjects not affected by OSA. METHODS: A cross-sectional controlled study was conducted on a group subjects studied by polygraphy (PG) at the snoring section of the ENT department, Sant'Orsola-Malpighi Hospital - University of Bologna. Patients who received a diagnosis of OSA were included in the study group and subjects with a negative PG diagnosis for Sleep Disordered Breathing and PG respiratory pattern that did not suggest the occurrence of sleep disorders were enrolled in the control group. Both the subjects included in the study group and the control group underwent an examination following the Diagnostic Criteria for Temporomandibular Disorders Axis I and II. RESULTS: Forty-three OSA patients (29 M, 16 F, mean age 52.26 ± 11.40) and 43 healthy controls (25 M, 18 F, mean age 49.95 ± 7.59) were included in the study. No significant differences were found between groups in demographic data. TMD prevalence and Axis II results did not differ between groups. CONCLUSIONS: This paper does not highlight a higher prevalence of TMDs in adults with OSA compared to healthy controls. Further high-quality studies are needed to confirm the results and to give possible pathophysiological explanations, providing reliable evidence.

Investigations on the Efficacy of Ozone as an Environmental Sanitizer in Large Supermarkets.

Awareness of the importance of the microbial contamination of air and surfaces has increased significantly during the COVID-19 pandemic. The aim of this study was to evaluate the presence of bacteria and fungi in the air and on surfaces within some critical areas of large supermarkets with and without an ozonation system. Surveys were conducted in four supermarkets belonging to the same commercial chain of an Apulian city in June 2021, of which two (A and B) were equipped with an ozonation system, and two (C and D) did not have any air-diffused remediation treatment. There was a statistically significant difference in the total bacterial count (TBC) and total fungal count (TFC) in the air between A/B and C/D supermarkets (p = 0.0042 and p = 0.0002, respectively). Regarding surfaces, a statistically significant difference in TBC emerged between A/B and C/D supermarkets (p = 0.0101). To the best of our knowledge, this is the first study evaluating the effect of ozone on commercial structures in Italy. Future investigations, supported by a multidisciplinary approach, will make it possible to deepen the knowledge on this method of sanitation, in light of any other epidemic/pandemic waves.

Predictors of response to sleep apnea surgery addressing the lateral pharyngeal wall collapse.

PURPOSE: To evaluate the predictive factors for surgical success in sleep apnea surgical techniques addressing the lateral pharyngeal wall. MATERIALS AND METHODS: This is a retrospective review of consecutive cases treated by functional expansion pharyngoplasty for OSA. Collected data included patients demographics, ENT physical examination and somnographic data. Furthermore inter pterygoid distance was assessed by CT scans. To determine predictors of surgical success, physical examination, CT findings, polysomnographic and demographic data were compared between the success and failure group. RESULTS: Fifty two patients were enrolled. The mean AHI decreased significantly from 44.3 to 17 (p = 0.001). A total of 33 patients (63.5%) met the surgical success criteria. An inter pterygoid distance longer than 34 mm was the only significant predictor of success. CONCLUSIONS: Inter pterygoid distance seems to be a promising parameter associated with the surgical outcomes that should be further studied to be validated as predictor of success.

Use of the Spare-Part Strategy to Reconstruct the External Auditory Canal After Subtotal Auriculectomy for Basal Cell Carcinoma.

After removal of an infiltrative BCC of the auditory meatus, a soft tissue defect of the temporal-mastoid area with bone exposure, needed reconstruction. Several options have been taken into account and a simple yet effective solution has been found following the spare-parts principle. The ear lobe, preserved during cancer removal, was split and used as a thin skin flap. Adequate coverage of the bone exposure and resurfacing of the external auditory canal was obtained with minimal donor site morbidity and a short surgery in a fragile patient with several comorbidities. The spare-parts strategy can provide successful solution to difficult reconstructive cases regardless of the anatomical area.

SARS-CoV-2 and Public Transport in Italy.

Although direct contact is considered the main mode of transmission of SARS-CoV-2, environmental factors play an important role. In this study, we evaluated the presence of SARS-CoV-2 on bus and train surfaces. From the buses, we took samples from the following areas: handrails used to enter or exit the bus, stop request buttons and handles next to the seats. From the trains, the sampled surfaces were handrails used to enter or exit the train, door open/close buttons, handles next to the seats, tables and toilet handles. SARS-CoV-2 was detected on 10.7% of the tested surfaces overall, 19.3% of bus surfaces and 2% of train surfaces (p < 0.0001). On the buses, the most contaminated surfaces were the handles near the seats (12.8%), followed by door open/close buttons (12.5%) and handrails (10.5%). Of the five analyzed transport companies, bus companies were the most contaminated, in particular, companies C (40%) and B (23.3%). A greater number of positive samples were found among those taken at 10:00 a.m. and 10:55 a.m. (45% and 40%, respectively). The presence of the virus on many bus surfaces highlights how the sanitation systems on public transport currently in use are not sufficient to limit the spread of SARS-CoV-2.

SARS-CoV-2 RNA and Supermarket Surfaces: A Real or Presumed Threat?

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged in March 2020 in Italy, leading to the pandemic of coronavirus disease 2019 (COVID-19) that continues to cause high global morbidity and mortality in human populations. Numerous studies have focused on the spread and persistence of the virus in the hospital setting. New scientific evidence shows that SARS-CoV-2 is present in different community environments. Although aerosol is one of the main routes of transmission for SARS-CoV-2, indirect contact through virus-contaminated surfaces could also play a key role. The survival and persistence of SARS-CoV-2 on surfaces appear to be influenced by the characteristics of the material, temperature, and humidity. In this study, we investigated the presence of SARS-CoV-2 RNA on surfaces in 20 supermarkets throughout the Apulia region during the lockdown period. We collected a total of 300 swab samples from various surfaces including supermarket scales, trolley handles, refrigerator and freezer handles, and keyboards. In total, 13 (4.3%) surfaces were positive for SARS-CoV-2 RNA contamination, with shopping trolley handles being the most frequently contaminated. This study showed that contamination in public spaces can occur, so we remark the importance to adopt adequate preventive measures, including environment ventilation, careful surfaces sanitation, hand hygiene, and correct usage of masks, to reduce the likelihood of virus transmission.

First Detection of Severe Acute Respiratory Syndrome Coronavirus 2 on the Surfaces of Tourist-Recreational Facilities in Italy.

A Coronavirus disease (COVID-19), caused by a new virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spreads via direct contact through droplets produced by infected individuals. The transmission of this virus can also occur via indirect contact if objects and surfaces are contaminated by secretions from individuals with COVID-19 or asymptomatic carriers. Environmental contamination with SARS-CoV-2 is high in hospital settings; on the contrary, surface contamination in non-healthcare settings is still poorly studied. In this study, the presence of SARS-CoV-2 on the surfaces of 20 tourist-recreational facilities was investigated by performing a total of 100 swabs on surfaces, including refrigerator handles, handrails, counters, tables, and bathroom access doors. Six (6%) swabs from four (20%) tourist-recreational facilities tested positive for SARS-CoV-2; the surfaces that were involved were toilet door handles, refrigerator handles, handrails, and bar counters. This study highlights that SARS-CoV-2 is also present in non-healthcare environments; therefore, in order to limit this worrying pandemic, compliance with behavioral rules and the adoption of preventive and protective measures are of fundamental importance not only in healthcare or work environments but also in life environments.

Early experience in tracheostomy and tracheostomy tube management in Covid-19 patients.

In Italy, we have experienced Europe's first and largest coronavirus outbreak. Based on our preliminary experience, we discuss the challenges in performing tracheotomy and tracheostoma care in the setting of a new pathogen.

Chemical Characterization, Gastrointestinal Motility and Sensory Evaluation of Dark Chocolate: A Nutraceutical Boosting Consumers' Health.

We performed a comprehensive study encompassing chemical characterization and sensory evaluation of two types of dark chocolate, i.e., artisanal (Choco-A) and industrial (Choco-I), as well as an evaluation of onset of gastrointestinal symptoms and gastrointestinal motility in healthy subjects fed with dark chocolate. Proteomic, lipid and metabolite analysis were performed by LC-MS/MS analysis and the total phenol content and antioxidant activity were estimated in both types of chocolate. Fifty healthy volunteers joined the study of the sensory characteristics of both types of chocolate; another 16 subjects underwent the study of gallbladder and gastric emptying by functional ultrasonography and orocecal transit time by lactulose H2-breath test after ingestion of dark chocolate. Identification of polyphenols, amino acids and fatty acids was carried out in both types of chocolate analysed, and results confirmed their richness in polyphenols, amino acid derivatives and fatty acids (FAs) either saturated (stearic, myristic, palmitic, ecosanoic) or unsaturated (oleic and linolenic). For agreeability, Choco-A scored higher than Choco-I for smell, texture, and taste and they did not show significant differences in the gastrointestinal motility. In conclusion as for gastrointestinal motility studies, we report that the ingestion of a small amount of chocolate induced a mild gallbladder, gastric contraction and a fast transit time compared to the test meal in healthy subjects.

Food Hygiene Surveillance in Italy: Is Food Ice a Public Health Risk?

Food ice is used as an ingredient or as a coolant in drinks and in the storage of food, especially fishery products. Studies show that ice can be polluted both by chemical substances and by bacteria and fungi. In particular, the presence of fungi in these food matrices has acquired an important role in Public Health, as it can represent a risk factor for fungal complications in immunocompromised subjects. In the present study we evaluated the hygiene-sanitary quality of food ice from public and collective catering establishments in a large area of Southern Italy, investigating the mandatory parameters (Escherichia coli, coliform and Enterococci) and some accessory parameters (Staphylococcus aureus, Pseudomonas aeruginosa and fungi) provided for Italian Legislative Decree 31/01. Although 54.5% of samples were compliant, the results highlight a vast contamination of food ice by bacteria and fungi. In particular, 95.8% of samples were contaminated by fungi, stressing no difference between compliant and non-compliant samples. Their presence is generally attributable to the poor sanitation conditions in the production and/or administration phase and to the incorrect sanitization and ordinary maintenance procedures. It seems appropriate to suggest the need to carry out a specific risk assessment with respect to the self-control plans.

New mineralocorticoid receptor antagonists: update on their use in chronic kidney disease and heart failure.

Aldosterone is a mineralocorticoid hormone with a well-known effect on the renal tubule leading to water retention and potassium reabsorption. Other major effects of the hormone include the induction of proinflammatory activity that leads to progressive fibrotic damage of the target organs, heart and kidney. Blocking the aldosterone receptor therefore represents an important pharmacological strategy to avoid the clinical conditions deriving from heart failure (CHF) and chronic kidney disease (CKD). However, steroidal mineralocorticoid receptor antagonists (MRA) have a low safety profile, especially in CKD patients due to the high incidence of hyperkalemia. A new generation of nonsteroidal MRA has recently been developed to obtain a selective receptor block avoiding side-effects like hyperkalemia and thereby making the drugs suitable for administration to CKD patients. This review summarizes the results of published preclinical and clinical studies on the nonsteroidal MRA, apararenone esaxerenone and finerenone. The trials showed a better safety profile with maintained drug efficacy compared with steroidal MRA. For this reason, nonsteroidal MRA represent an interesting new therapeutic approach for the prevention of CHF and CKD progression. Some basic research findings also yielded interesting results in acute clinical settings such as myocardial infarction and acute kidney injury.

Relationship between cephalometric parameters and the apnoea-hypopnoea index in OSA patients: a retrospective cohort study.

OBJECTIVE: The purpose of this study was to assess the relationship between cephalometric parameters and apnoea-hypopnoea index (AHI) controlling for the effect of gender, age, and body mass index (BMI) on a large sample of patients with obstructive sleep apnoea (OSA). METHODS: This retrospective cohort study was conducted on the lateral cephalograms of 253 Caucasian adult OSA patients. Cephalometric analyses were performed using 14 parameters for skeletal and soft tissue morphology, including antero-posterior and vertical jaw relationships, hyoid bone position, soft palate length and thickness, airway space, and tongue length and height. A hierarchical regression was run to examine the amount of variability in AHI that cephalometric variables explained after controlling for patients' general characteristics (gender, age, and BMI). RESULTS: After controlling for gender, age, and BMI, the increase in AHI variance accounted for by cephalometric parameters was equal to 0.103. Among the cephalometric variables, only MP-H and PNS-P were statistically significant (P < 0.05). LIMITATIONS: Given the retrospective nature of the study, it is difficult to assess whether other confounding variables not considered in the present study could have influenced the relationship between cephalometric parameters and AHI. CONCLUSIONS: This study revealed the existence of a relationship between OSA severity and some cephalometric parameters. Indeed soft palate length and vertical position of the hyoid bone were significant predictors of AHI in adult Caucasian OSA patients.

Maximum voluntary retrusion or habitual bite position for mandibular advancement assessment in the treatment of obstructive sleep apnoea patients.

BACKGROUND: There is no consensus on whether the range of mandibular advancement for the construction of mandibular advancement devices in obstructive sleep apnoea (OSA) patients should be measured from a starting position of maximum voluntary retrusion or habitual bite position. OBJECTIVE: The purposes of this study were to investigate the differences in mandibular advancement registrations starting from maximum voluntary retrusion or from habitual bite position and to evaluate the reliability of these assessments. METHODS: A retrospective cohort analysis of 126 patients with OSA was performed. All patients had their mandibular range of motion evaluated twice (starting from maximum voluntary retrusion and from habitual bite position) through the George Gauge before undergoing drug-induced sleep endoscopy. The Dahlberg formula and paired t test were used to calculate random and systematic errors of dental positions assessment. Test-retest reliability was quantified using the intra-class correlation coefficient (ICC). RESULTS: The mean mandibular range starting from maximum voluntary retrusion and from habitual bite position were 12.49 ± 2.19 mm and 7.68 ± 2.29 mm, respectively, with a mean distance between the two starting positions of 4.81 ± 1.75 mm. No systematic error was found (P > .05), and random errors ranged from 0.30 to 0.95 mm. ICC values were excellent for maximum voluntary protrusion (ICC = 0.986) and maximum voluntary retrusion (ICC = 0.956), whereas habitual bite position showed a good value (ICC = 0.818). CONCLUSION: The difference between maximum voluntary retrusion and habitual bite position is potentially relevant. Maximum retrusion is advisable as starting point of the mandibular advancement registration since it provides a more reliable measure.

Solitary Fibrous Tumor of the Tongue: An Uncommon Cause of Obstructive Sleep Apnea.

INTRODUCTION: Solitary fibrous tumor is an uncommon mesenchymal neoplasm that may be found in any location. To date, only a few cases of solitary fibrous tumor involving the tongue have been reported. CASE SUMMARY: We present the case of a 31-year-old man with a history of progressively worsening snoring and daytime sleepiness. Polysomnography revealed severe obstructive sleep apnea. An attempt to treat sleep apnea by continuous positive airway pressure and oral appliance led to a poor clinical response. CT and MRI scans findings revealed a large mass in the tongue base partially obstructing the airway. After the excision of the mass all symptoms, included daytime somnolence, disappeared and a polysomnographic examination showed the normalization of the somnographic parameters. DISCUSSION: Although OSA is rarely caused by tumors, each patient with sleep disorders breathing should be examined carefully for the potential presence of an upper aero-digestive tract neoplasm that may contribute to obstruction.

European position paper on drug-induced sleep endoscopy: 2017 Update.

BACKGROUND: The first edition of the European position paper (EPP) on drug-induced sleep endoscopy (DISE) was published in 2014 with the aim to standardise the procedure, to provide an in-depth insight into the main aspects of this technique and to have a basis for future research. Since 2014, new studies have been published concerning new sedative agents or new insights into the pattern/levels of the obstruction depending on the depth of sedation. Therefore, an enlarged group of European experts in the field of sleep breathing disorders (SBD), including the most of the first DISE EPP main authors, has decided to publish an update of the European position paper on DISE, in order to include new evidence and to find a common language useful for reporting the findings of this endoscopic evaluation in adult population affected by SBD. METHODS: The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centres in order to provide an update regarding the standardisation of the DISE procedure and an in-depth insight into the main aspects of this technique. RESULTS: After the first European Position Consensus Meeting on DISE and its update, consensus was confirmed for indications, required preliminary examinations, where to perform DISE, technical equipment required, staffing, local anaesthesia, nasal decongestion, other medications, patient positioning, basics and special diagnostic manoeuvres, drugs and observation windows. So far, no consensus could be reached on a scoring and classification system. However, regarding this aim, the idea of an essential classification, such as VOTE with the possibility of its graded implementation of information and descriptions, seems to be the best way to reach a universal consensus on DISE classification at this stage. A common DISE language is mandatory, and attempts to come to a generally accepted system should be pursued.

Phenotyping the pathophysiology of obstructive sleep apnea using polygraphy/polysomnography: a review of the literature.

Continuous positive airway pressure (CPAP) is the first-line treatment for the majority of patients affected by obstructive sleep apnea syndrome (OSA). However, long-term compliance with CPAP therapy may result limited and alternatives to CPAP therapy are required to address the increasing need to provide tailored therapeutic options. Understanding the pathophysiological traits (PTs) of OSA patients [upper airway (UA) anatomical collapsibility, loop gain (LG), arousal threshold (AT), and UA gain (UAG)] lies at the heart of the customized OSA treatment. However, sleep research laboratories capable to phenotype OSA patients are sparse and the diagnostic procedures time-consuming, costly, and requiring significant expertise. The question arises whether the use of routine clinical polysomnography or nocturnal portable multi-channel monitoring (PSG/PM) can provide sufficient information to characterize the above traits. The aim of the present review is to deduce if the information obtainable from the clinical PSG/PM analysis, independently of the scope and context of the original studies, is clinically useful to define qualitatively the PTs of individual OSA patients. In summary, it is possible to identify four patterns using PSG/PM that are consistent with an altered UA collapsibility, three that are consistent with altered LG, two with altered AT, and three consistent with flow limitation/UA muscle response. Furthermore, some PSG/PM indexes and patterns, useful for the suitable management of OSA patient, have been discussed. The delivery of this clinical approach to phenotype pathophysiological traits will allow patients to benefit in a wider range of sleep services by facilitating tailored therapeutic options.