Indoor air quality at life and work environments in Rome, Italy.

The air quality of three different microenvironments (school, dwelling, and coffee bar) located in the city of Rome, Italy, was assessed. Indoor and outdoor concentrations of polycyclic aromatic hydrocarbons (PAHs) associated with PM2.5 particles were determined during an intensive 3-week sampling campaign conducted in March 2013. In interiors, total particulate PAHs ranged from 1.53 to 4.96 ng/m(3) while outdoor air contained from 2.75 to 3.48 ng/m(3). In addition, gaseous toxicants, i.e., NO2, NOx , SO2, O3, and BTEX (benzene, toluene, ethyl-benzene, and xylene isomers), were determined both in internal and external air. To solve the origin of indoor and outdoor PAHs, several source apportionment methods were applied. Multivariate analysis revealed that emissions from motor vehicles, biomass burning for heating purposes, and soil resuspension were the major sources of PAHs in the city. No linear correlation was established between indoor and outdoor values for PM2.5 and BTEX; the respective indoor/outdoor concentration ratios exceed unity except for PM2.5 in the no smoking home and benzene in all school floors. This suggests that important internal sources such as tobacco smoking, cleaning products, and resuspension dust contributed to indoor pollution. Using the monitoring stations of ARPA Lazio regional network as reference, the percentage within PAH group of benzo[a]pyrene, which is the WHO marker for the carcinogenic risk estimates, was ca. 50% higher in all locations investigated.

Epidemiological and clinical characteristics of patients attending STI clinics in Tuscany, Italy: a multicenter report on new infections in 2011.

AIM: The aim of this study was to assess the demographic, behavioral and clinical features associated with newly diagnosed sexually transmitted infections (STIs) among attendees from four STI Clinics during 2011 in Tuscany, Central Italy. METHODS: Electronic and non-electronic medical records of attendees were reviewed to collect socio-demographical and anamnestic characteristics of patients, and to assess the annual incidence and distribution of STIs. RESULTS: The study included 1293 subjects, for a total number of 1394 newly diagnosed STIs. The male/female ratio was about 2:1, and Italian nationality accounted for 84.1% of the sample. MSM represented the 25.9% of the male population. Condom use was very poor in the large majority of our sample. Genital warts and non-gonococcal cervicitis and urethritis were the most frequent STIs. Anamnestic STIs were recorded in 350 subjects. When stratified for sexual preference, men who have sex with men were found at four to ten fold increased risk for syphilis, gonorrhoeae and HIV infection. New diagnoses of syphilis, gonorrhoea, urethritis and molluscum were strictly associated with infections by the same pathogens in the past (re-infections). CONCLUSIONS: Results show that STIs in Tuscany involve a mixed young to adult population, composed by both heterosexual and homosexual subjects who practice unprotected sex and do not seem to be conscious of the associated risks, as demonstrated by the high rates of coinfections and reinfections. These findings reinforce the need for greater education and prevention efforts for HIV and other STIs among the Tuscan population.

Gender differences in HIV infection: is there a problem? Analysis from the SCOLTA cohorts.

OBJECTIVES: Evaluate gender differences with regard to baseline characteristics and outcome of therapy in cohorts of the SCOLTA (surveillance cohort long-term toxicity of antiretrovirals) project. METHODS: The SCOLTA project is an active pharmacovigilance system for new antiretroviral drugs. Since 2002, patients were enrolled in nine cohorts (lopinavir, tenofovir, atazanavir, fosamprenavir, enfuvirtide, tipranavir, darunavir, raltegravir and maraviroc). RESULTS: Two thousand one hundred and fifty-four patients were included in 5 PI cohorts; 607 (28.2%) were female. Women were younger and less frequently HCV-coinfected than men. At study entry, they were less frequently in CDC stage C, but CD4+ cells/mm(3) and detectable HIV-RNA were not different by gender. Women had triglycerides alterations less frequently than men, but showed a higher proportion of low HDL-cholesterol. Women were protected from incident grade 2-4 triglycerides increase (odds ratio=0.39, 95% confidence interval 0.18-0.88; P=0.02). Mean CD4+ cell count increased in both men and women; despite a non-significantly lower initial CD4+ level, women had a better immunological recovery. Women discontinued PI treatment for adverse events and their own will more frequently. CONCLUSIONS: In these cohorts, gender distribution mirrored the Italian HIV population. Women were younger than men when they started their first ARV therapy and when they entered our cohorts. On the same treatment, they had a better immune response, though no significant difference emerged on virologic control and treatment durability. As compared to men, women appeared at lower risk of hypertriglyceridaemia. They stopped PI-based treatment of their own will more frequently than men, suggesting the need for a focused effort on adherence.

Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001-2011.

OBJECTIVE: We used data from a national study of pregnant women with HIV to evaluate the prevalence of congenital abnormalities in newborns from women with HIV infection. DESIGN: Observational study. SETTING: University and hospital clinics. POPULATION: Pregnant women with HIV exposed to antiretroviral treatment at any time during pregnancy. METHODS: The total prevalence of birth defects was assessed on live births, stillbirths, and elective terminations for fetal anomaly. The associations between potentially predictive variables and the occurrence of birth defects were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs) for exposed versus unexposed cases, calculated in univariate and multivariate logistic regression analyses. MAIN OUTCOME MEASURES: Birth defects, defined according to the Antiretroviral Pregnancy Registry criteria. RESULTS: A total of 1257 pregnancies with exposure at any time to antiretroviral therapy were evaluated. Forty-two cases with major defects were observed. The total prevalence was 3.2% (95% CI 1.9-4.5) for exposure to any antiretroviral drug during the first trimester (23 cases with defects) and 3.4% (95% CI 1.9-4.9) for no antiretroviral exposure during the first trimester (19 cases). No associations were found between major birth defects and first-trimester exposure to any antiretroviral treatment (OR 0.94, 95% CI 0.51-1.75), main drug classes (nucleoside reverse transcriptase inhibitors, OR 0.95, 95% CI 0.51-1.76; non-nucleoside reverse transcriptase inhibitors, OR 1.20, 95% CI 0.56-2.55; protease inhibitors, OR 0.92, 95% CI 0.43-1.95), and individual drugs, including efavirenz (prevalence for efavirenz, 2.5%). CONCLUSIONS: This study adds further support to the assumption that first-trimester exposure to antiretroviral treatment does not increase the risk of congenital abnormalities.

Induced first abortion rates before and after HIV diagnosis: results of an Italian self-administered questionnaire survey carried out in 585 women living with HIV.

OBJECTIVES: The aim of the study was to investigate whether HIV diagnosis affected reproductive planning over time and to assess independent predictors of abortion overall and following HIV diagnosis. METHODS: Donne con Infezione da HIV (DIDI) is an Italian multicentre study based on a questionnaire survey carried out in 585 HIV-positive women between November 2010 and February 2011. The incidence and predictors of abortion were measured by person-years analysis and Poisson regression. RESULTS: The crude incidence rate of abortion was 18.8 [95% confidence interval (CI) 16.5-21.4] per 1000 person-years of follow-up (PYFU). Compared with women who terminated their pregnancy before HIV diagnosis, women who terminated their pregnancy after HIV diagnosis but before 1990 showed a 2.56-fold (95% CI 1.41-4.65) higher risk. During 1990-1999 and 2000-2010, HIV diagnosis was not significantly associated with outcome [adjusted rate ratio (ARR) 0.93 (95% CI 0.55-1.59) and ARR 0.69 (95% CI 0.32-1.48), respectively]. Age [ARR 0.96 (95% CI 0.94-0.99) per 1 year older] and injecting drug use [ARR 1.38 (95% CI 0.98-1.94)] were found to be predictors of abortion overall. After HIV diagnosis, being on combination antiretroviral therapy [ARR 0.54 (95% CI 0.28-1.02)], monthly income < €800 [ARR 1.76 (95% CI 0.99-3.12)], younger age [ARR 0.95 (95% CI 0.91-1.00) per 1 year older] and fear of vertical transmission [ARR 1.95 (95% CI 1.04-3.67)] were found to be independently associated with abortion. CONCLUSIONS: We observed a higher incidence of abortion compared with data available for the general Italian population. Awareness of HIV diagnosis was predictive of abortion only in the 1980s. Women with HIV infection are still worried about vertical HIV transmission. Interventions promoting HIV screening among women who plan to have an abortion and informative counselling on motherhood planning in the setting of HIV care are needed.

Efficacy and safety of boosted and unboosted atazanavir-containing antiretroviral regimens in real life: results from a multicentre cohort study.

BACKGROUND: Atazanavir (ATV) has demonstrated high efficacy and safety in both treatment-naïve and treatment-experienced patients. Some comparative data are available on the durability of ritonavir-boosted (ATV/r) and unboosted formulations, but there are no data on clinicians' motivations for choosing one or another in everyday practice. The aim of this study was to evaluate the long-term efficacy of boosted and unboosted ATV in a cohort of treatment-experienced patients. METHODS: All patients included in the study were enrolled in an observational cohort within the Surveillance Cohort Long-Term Toxicity Antiretrovirals (SCOLTA) Project. Data on CD4 cell count, HIV viral load, metabolic parameters and adverse events of grade 3-4 are collected through an on-line system every six months. The duration of treatment with ATV was evaluated using the Kaplan-Meier curve and boosted and unboosted regimens were compared using the log-rank test. RESULTS: A total of 509 patients starting ATV as a component of their antiretroviral therapy were enrolled in the SCOLTA Project at the time of the study. Boosted ATV was received by 379 patients (74.5%) while 130 (25.5%) were treated with the unboosted formulation. The last therapeutic regimen did not influence the choice of ATV formulation. The mean observational time was 23.9 months. At the end of follow-up, 58.5% of patients on unboosted ATV and 58.1% of patients on ATV/r continued the treatment and no statistically significant differences were observed for ATV durability between the formulations or among the single causes of therapy interruption. CONCLUSIONS: Our results suggest that, in unselected clinical settings, ATV-containing antiretroviral therapy is durable and safe in both its formulations.

Women facing HIV. Key question on women with HIV infection: Italian consensus workshop.

A panel of leading Italian specialists in infectious diseases, obstetrics and gynaecology met in a national consensus workshop on women facing HIV to review critical aspects and discuss recommendations for selected key questions on four issues: (1) women and highly active antiretroviral therapy (HAART): access to care and adherence to therapy, side effects and drug-drug interaction; (2) HIV-infected pregnant women: prevention of mother to child transmission; (3) desire for children among women living with HIV: assisted reproduction; (4) sexually transmitted diseases and genital disturbances. The method of a nominal group meeting was used, and recommendations were graded for their strength and quality of evidence using a system based on the one adopted by the Infectious Diseases Society of America. Main conclusions are summarized and critically discussed, and some of the most recent data supporting recommendations are provided.

Treatment of human immunodeficiency virus-associated facial lipoatrophy with lipofilling and submalar silicone implants.

In the absence of a current therapy to prevent facial lipoatrophy in HIV+ patients treated with HAART, surgical correction of the defect still remains the best option. We evaluate two different surgical techniques for facial contour enhancing and suggest the right choice related to the lipodystrophy severity. Twelve HIV+ patients underwent surgical submalar correction: eight were treated with lipofilling following Coleman's technique and four had bilateral malar silicone implants inserted after determining their positioning with the aid of a new software. Both techniques gave long lasting results in facial contour reshaping ranging from good to very good. No complication was observed. In the mean follow-up period of 2 years no patient felt uncomfortable with his/her image. Both techniques, lipofilling and silicone implant positioning, for managing facial lipoatrophy in HIV+ patients treated with HAART had good results, but the right choice has to be related to the severity of the lipodystrophy in the patient.

Quality of life and body image in the assessment of psychological impact of lipodystrophy: validation of the Italian version of assessment of body change and distress questionnaire.

Lipodystrophy (LD) includes morphologic changes that are distressing to patients with HIV. We tested the validity of an Italian version of the Assessment of Body Change and Distress (ABCD) questionnaire and analysed its relationship to physical and mental aspects of Health-Related Quality of Life. Two hundred and fifty-two patients completed the questionnaires. Construct validity of the ABCD was tested against the MOS-HIV Health Survey, body mass-index (BMI) and CD4+ T-lymphocyte counts. Cronbach's alpha for the ABCD total score was 0.94. The ABCD showed the hypothesized moderate correlations to MOS-HIV scales and clinical variables. Preliminary evidence supports the reliability and validity of the Italian version of the ABCD in people with HIV and LD. This questionnaire may be useful to identify people experiencing greater impact of LD, or to evaluate the impact of interventions to treat LD such as plastic surgery.

Development and field evaluation of a new diffusive sampler for hydrogen sulphide in the ambient air.

A diffusive sampler for the determination of hydrogen sulphide (H2S) based on collection on a paper filter coated with silver nitrate followed by optical densitometric determination of the metal sulphide was developed. Laboratory tests were conducted in controlled atmosphere to evaluate linearity, uptake rate, face velocity effects, sample stability, influence of relative humidity and of interferents, precision and accuracy. The measured uptake rate for H2S was determined in experiments involving sampling at different concentration levels in comparison to a wet standard colorimetric technique. The precision of the measurements for co-located passive samplers was lower than 15%. The accuracy of the data collected is within 20% of the actual value measured by the wet method. The sampler is capable of reliable measurements of H2S at common levels of a polluted atmosphere in urban settings yielding average concentration levels over one month and beyond. Diffusive sampling can be adopted to analyse in detail the temporal and spatial trends of H2S concentration in ambient air and in specific historic buildings or in museums.

Mucosal and systemic immune activation is present in human immunodeficiency virus-exposed seronegative women.

Immune parameters were analyzed in peripheral blood mononuclear cells (PBMC) and cervical mucosa biopsy specimens of human immunodeficiency virus (HIV)-seronegative women sexually exposed to HIV (exposed seronegative [ESN]), HIV-infected women, and healthy women without HIV exposure. HIV was not detected in PBMC or cervical mucosa biopsy specimens of ESN women. However, interleukin (IL)-6, IL-10, IL-12, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha and -beta mRNA were elevated in PBMC and cervical mucosa biopsy specimens of ESN and HIV-infected women; CCR5 and CXCR4 mRNA were augmented in cervical mucosa biopsy specimens, but not in PBMC, of ESN and HIV-infected women; HIV-specific IFN-gamma-secreting cells were detected in vaginal washes of ESN and HIV-infected women; and phenotypic alterations were present in PBMC of ESN women. These results suggest that active HIV infection is not required for T cell activation; immune alterations occur in women in whom HIV infection cannot be detected virologically or clinically.

'Reversible cardiomyopathy' in patients with severe scorpion envenoming by Tityus serrulatus: evolution of enzymatic, electrocardiographic and echocardiographic alterations.

Severe scorpion envenoming is characterized by cardiocirculatory failure which may lead to pulmonary oedema. These are the major causes of death among victims of scorpion stings. Involvement of the heart has been attributed to the massive release of catecholamines and/or to a direct toxic effect of the venom on cardiac fibres, while pulmonary oedema has been considered to be of cardiogenic or non-cardiogenic origin. We present here the clinical, laboratory, electrocardiographic and echocardiographic data of 12 victims of severe Tityus serrulatus stings. These patients had important echocardiographic evidence of moderate to severe left ventricular (LV) dysfunction with diffuse LV hypokinesia and reduced ejection fraction. Seven developed pulmonary oedema. The clinical course of all the patients was satisfactory and the laboratory, electrocardiographic and echocardiographic changes returned to normal, usually within 1 week of the sting. The important alterations detected by echocardiography as early as during the 1st few hours after the sting, taken together with the enzymatic and electrocardiographic data, confirm that LV dysfunction is responsible, either alone or in combination with other factors, for the cardiac insufficiency and pulmonary oedema encountered in scorpion envenoming.

[Treatment of mild and moderate cardiac failure with captopril. A multicenter study]. / Tratamento da insuficiência cardíaca leve e moderada com captopril. Estudo multicêntrico.

PURPOSE: Evaluation of the clinical effects of captopril addition to the conventional therapy of functional class II and III (NYHA) congestive heart failure (CHF). METHODS: One hundred and fifteen patients with CHF, 46 (40%) class II and 69 (60%) class III, on conventional treatment (digitalis and diuretic) were the subject of this study. The age ranged from 22 to 75 years (mean 56.6 +/- 11); 67 were male and 66 were caucasians. The etiologies of the heart failure were: hypertensive heart disease 47 (40.9%), ischemic heart disease 27 (23.5%), Chagas cardiomyopathy 20 (17.4%), idiopathic cardiomyopathy 15 (13.0%), and other causes 6 (5.2%). Diuretic and digitalis were maintained in the same dosage during all the treatment. Captopril therapy was started with 6.25 mg b.i.d. or t.i.d., and the dosage was increased gradually to 25 mg b.i.d. or t.i.d. The duration of the study was 12 weeks. Clinical visits occurred every four weeks and laboratory tests were performed in the beginning and at the end of the study. RESULTS: The dosage of captopril ranged from 12.5 to 75 mg (mean 28.5 +/- 13.1 mg/day). The addition of captopril to the conventional therapy of CHF was associated with significant reduction (p < 0.01) of heart rate, systolic and diastolic blood pressure. In the end of the study 13 patients (11.3%) were in functional class III, 50 (43.5%) in class II and 52 (45.2%) in class I. Globally, functional class was improved in 98 (85.2%) patients and remained unchanged in 17 (14.8%) (p < 0.01). The side effects (dizziness, cough, hypotension and headache) were moderate and uncommon and did not need interruption of the treatment. CONCLUSION: The addition of captopril to the conventional therapy of class II and III CHF was associated with significant improvement of functional class and with good tolerability.

Human immunodeficiency virus type 1 infection in a community of southern Mozambique.

We report the results of a study held between 1986 and 1988 on a population constituted by 493 subjects (425 of Mozambican nationality) all living in the camp organized for the building of the dam in Corumana (Sabiè district, Maputo). We found five subjects, all of them from Mozambique, seropositive for HIV-1 antibodies (ELISA and WB) with a prevalence of 1.2%. Four of the positive samples came from female subjects (1.7% of 239 females tested); one positive sample came from a male subject (0.5% of 186 tested).

[Inequalities among hospitalized patients due to cardiac and cerebrovascular diseases in localities of the State of São Paulo (Brazil), 1986]. / Desigualdades entre pacientes hospitalizados por doenças cardíacas e vasculares-cerebrais em localidade do Estado de São Paulo (Brasil), 1986.

The clinical and epidemiological characteristics of hospitalizations due to cardiac and cerebral-vascular diseases (CCVD-ICD 390-438), which occurred in 1986, were studied on the basis of data from an information system relating to medical care in the City of Ribeirão Preto, State of S. Paulo, Brazil. These causes accounted for 4,673 of the annual total of 43,449 hospital admissions. Using the sources of payment of the hospitalization as an indicator of the patients' social strata, the following four study groups were defined: private, social insurance, non-paying and "others". These groups showed significant differences in relation to the following variables: hospitalization rates due to CCVD, mean and median age at admission and time of death, occupation, average length of stay in the hospital, mortality rates and relative frequencies of specific sub-group diagnosis. These differences are attributed to inequalities in the standard of living and in the working conditions of the groups, which determine diverse patterns of disease, medical care and mortality.

Marginal malnutrition and reduced physical work capacity of migrant adolescent boys in Southern Brazil.

We measured the effect of marginal malnutrition on physical work capacity of adolescent children of agricultural migrant workers in Southern Brazil. Nutritional status was evaluated using 24-h dietary recall. Body size was evaluated anthropometrically. Biochemical assessments were also made. Physical work capacity (PWC170) was assessed by measuring heart rate, blood lactic acid levels, and oxygen consumption during submaximal bicycle ergometer work. The same tests were also carried out on a comparable group of local well-to-do boys of the same age in the same community who served as controls. The dietary results suggest that adolescent boys of migrant families were marginally malnourished. Their physical growth and development were retarded by at least 1 yr. They had significantly lower reserves of body fat and less muscle mass when compared with controls. Their Hb levels were normal. At the submaximal work loads measured (0, 25, 50, 75 W) the migrant children exhibited similar oxygen consumption and gross exercise efficiency as the control children, but achieved this work at a higher percentage of their maximum work capacity as shown by significantly higher heart rates for the same oxygen consumption. Higher blood lactic acid levels in the migrant children suggest that the available muscle mass was under greater stress to accomplish the same task. PWC170 was reduced one-third in the migrant children (migrant 643 +/- 162 kpm/min, control 905 +/- 345 kpm/min; p less than 0.005). These differences were largely associated with weight (migrant 20.6 +/- 5.9 kpm/min; control 18.8 +/- 4.3 kpm/kg/min; p greater than 0.1). These observations suggest that marginal as well as severe malnutrition affect physical work capacity at levels low enough to affect growth and development.