The Erice 58 Charter on 'The health of migrants. An equity challenge for the public health system'.

Abstract: The Erice 58 Charter titled "The Health of Migrants: a Challenge of Equity for the Public Health System", was unanimously approved at the conclusion of the 58th Residential Course of the School of Epidemiology and Preventive Medicine 'Giuseppe D'Alessandro' entitled "The Health of Migrants: a Challenge of Equity for the Public Health System. Epidemiological, clinical-relational, regulatory, organisational, training and public communication aspects at international, national and local level', which took place from 28 March to 2 April 2022 in Erice (Sicily, Italy), at the 'Ettore Majorana' Foundation and Centre for Scientific Culture. The Course was promoted by the Italian Society of Migration Medicine (S.I.M.M.) and the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI), with the collaboration and patronage of the Istituto Superiore di Sanità (ISS). 72 learners participated (mainly resident doctors in 'Hygiene and Preventive Medicine' but also other health service professionals), whose average age was 37 years; on the basis of territorial origin, 13 of the 20 Italian regions were represented. During the intense learning experience, which consisted of 18 frontal lessons (with 20 lecturers from the bio-medical, socio-anthropological and journalistic fields) and 7 working group sessions (supported by 4 classroom tutors in addition to the lecturers) in 'blended learning' mode, the various dimensions and critical issues related to the possibility of guaranteeing truly inclusive health policies for foreigners/migrants, throughout the country, were identified and discussed from an 'Health Equity' perspective. This enabled a small editorial group to draw up the basic document that, in the last session of the Course, was discussed and modified by all participants into the version of the 'Erice 58 Charter' presented here.

Vitamin D replacement ameliorates serum lipoprotein functions, adipokine profile and subclinical atherosclerosis in pre-menopausal women.

BACKGROUND AND AIMS: Low vitamin D (vitD) has been linked to increased cardiovascular (CV) risk, but the effects of vitD supplementation are not clarified. We evaluated the impact of vitD normalization on HDL cholesterol efflux capacity (CEC), which inversely correlates with CV risk, the proatherogenic serum cholesterol loading capacity (CLC), adipokine profile and subclinical atherosclerosis. METHODS AND RESULTS: Healthy premenopausal women with vitD deficiency (n = 31) underwent supplementation. Subclinical atherosclerosis was evaluated by flow-mediated dilation (FMD), pulse wave velocity (PWV) and augmentation index (AIx), measured with standard techniques. HDL CEC and serum CLC were measured by a radioisotopic and fluorimetric assay, respectively. Malondialdehyde (MDA) in HDL was quantified by the TBARS assay. Pre-ß HDL was assessed by 2D-electrophoresis. Serum adipokines were measured by ELISA. VitD replacement restored normal levels of serum 25-hydroxyvitamin D (25OHD) and significantly improved FMD (+4%; p < 0.001), PWV (-4.1%: p < 0.001) and AIx (-16.1%; p < 0.001). Total CEC was significantly improved (+19.5%; p = 0.003), with a specific increase in the ABCA1-mediated CEC (+70.8%; p < 0.001). HDL-MDA slightly but significantly decreased (-9.6%; p = 0.027), while no difference was detected in pre-ß HDL. No change was observed in aqueous diffusion nor in the ABCG1-mediated CEC. Serum CLC was significantly reduced (-13.3%; p = 0.026). Levels of adiponectin were increased (+50.6%; p < 0.0001) and resistin levels were decreased (-24.3%; p < 0.0001). After vitD replacement, an inverse relationship was found linking the ABCA1-mediated CEC with pre-ß HDL (r2 = 0.346; p < 0.001) and resistin (r2 = 0.220; p = 0.009). CONCLUSION: Our data support vitD supplementation for CV risk prevention.

Relación entre los Niveles de Fibrinógeno e Insulina con los Parámetros que Definen al Síndrome Metabólico / Relationship between Insulin levels with Fibrinogen and parameters defining the Metabolic Syndrome

Metabolic syndrome is a combination of risk factors that increase an individual's chance of developing ischemic cardiovascular diseases which are the leading cause of death worldwide. In a number of metabolic syndrome abnormalities such as impaired secretion of acute phase reactants and certain hormones, such as the case of fibrinogen and insulin respectively. In this research fibrinogen levels were correlated with insulin and the factors that define the metabolic syndrome according to NCEP- ATP III in a population from the Municipality Francisco Linares Alcántara aged 35 and 60, the sample consisted of 30 patients and 29 controls. Was made comparison of means of anthropometric parameters and biochemical testing using the Wilcoxon signed ranks with a statistical significance (p < 0.05) and Spearman correlation analysis between insulin and fibrinogen levels with anthropometric and biochemical parameters studied was made it was found that patients had higher BMI, glucose , triglycerides, VLDL-C , insulin and fibrinogen compared to controls. Furthermore, the latter showed the highest HDL-C value compared with patients . On the other hand there was a positive association between insulin levels with BMI and glycemic variables . There was a negative association between levels of fibrinogen and LDL cholesterol variables in patients. No association between insulin levels and fibrinogen was found.

El síndrome metabólico es la conjunción de factores de riesgo en un individuo que aumentan su probabilidad de padecer enfermedades cardiovasculares isquémicas las cuales constituyen la primera causa de muerte a nivel mundial. En el síndrome metabólico se desencadenan una serie de anomalías como ejemplo alteración en la secreción de reactantes de fase aguda y de ciertas hormonas, como el caso del fibrinógeno y la insulina respectivamente. En esta investigación se correlacionaron los niveles de fibrinógeno y la insulina con los factores que definen al síndrome metabólico según la NCEP-ATP III en una población procedente del Municipio Francisco Linares Alcántara en edades comprendidas entre 35 y 60 años. La muestra estaba conformada entre 30 pacientes y 29 controles. Se hizo comparación de medias de los parámetros antropométricos y bioquímicos utilizando la prueba de los rangos con signo de Wilcoxon con una significancia estadística de (p<0,05). De igual modo se realizó análisis de correlación de Spearman entre los niveles de Insulina y fibrinógeno con los parámetros antropométricos y bioquímicos estudiados se encontró que los pacientes tenían más elevado el IMC, glicemia, triglicéridos, VLDLc, insulina y fibrinógeno con respecto a los controles. Además, estos últimos presentaron el valor de HDLc más elevado comparado con el de los pacientes. Por otro lado hubo asociación positiva entre los niveles de insulina con las variables IMC y glicemia. Hubo asociación negativa entre los niveles de fibrinógeno con las variables colesterol y LDLc en los pacientes. No se encontró asociación entre los niveles de insulina y fibrinógeno.

Gene flow and population structure of a common agricultural wild species (Microtus agrestis) under different land management regimes.

The impact of landscape structure and land management on dispersal of populations of wild species inhabiting the agricultural landscape was investigated focusing on the field vole (Microtus agrestis) in three different areas in Denmark using molecular genetic markers. The main hypotheses were the following: (i) organic farms act as genetic sources and diversity reservoirs for species living in agricultural areas and (ii) gene flow and genetic structure in the agricultural landscape are influenced by the degree of landscape complexity and connectivity. A total of 443 individual voles were sampled within 2 consecutive years from two agricultural areas and one relatively undisturbed grassland area. As genetic markers, 15 polymorphic microsatellite loci (nuclear markers) and the central part of the cytochrome-b (mitochondrial sequence) were analysed for all samples. The results indicate that management (that is, organic or conventional management) was important for genetic population structure across the landscape, but that landscape structure was the main factor shaping gene flow and genetic diversity. More importantly, the presence of organically managed areas did not act as a genetic reservoir for conventional areas, instead the most important predictor of effective population size was the amount of unmanaged available habitat (core area). The relatively undisturbed natural area showed a lower level of genetic structuring and genetic diversity compared with the two agricultural areas. These findings altogether suggest that political decisions for supporting wildlife friendly land management should take into account both management and landscape structure factors.

Permanent genetic resources added to Molecular Ecology Resources Database 1 August 2012 - 30 September 2012.

This article documents the addition of 83 microsatellite marker loci and 96 pairs of single-nucleotide polymorphism (SNP) sequencing primers to the Molecular Ecology Resources Database. Loci were developed for the following species: Bembidion lampros, Inimicus japonicus, Lymnaea stagnalis, Panopea abbreviata, Pentadesma butyracea, Sycoscapter hirticola and Thanatephorus cucumeris (anamorph: Rhizoctonia solani). These loci were cross-tested on the following species: Pentadesma grandifolia and Pentadesma reyndersii. This article also documents the addition of 96 sequencing primer pairs and 88 allele-specific primers or probes for Plutella xylostella.

Effects of antihypertensive treatments on incidence of diabetes: a case-control study.

AIMS: Aim of this case-control study is the assessment of the relationship between antihypertensive treatment and incidence of diabetes in an unselected cohort of subjects participating in a screening program for diabetes. METHODS: A case-control study nested within a cohort of nondiabetic subjects with a mean follow-up of 27.7 ± 11.3 months was performed, comparing 40 cases of incident diabetes and 160 controls matched for age, sex, body mass index, fasting plasma glucose, 2-h post-load glycemia, smoking and alcohol abuse. RESULTS: When considering antihypertensive treatment at enrolment, a lower proportion of cases was exposed to ACE-inhibitors/angiotensin receptor blockers (ACE-i/ARB) in comparison with controls. A non-significant trend toward a higher exposure to diuretics, which were mainly represented by thiazide diuretics, was observed in cases. In a multivariate analysis, including both ACE-i/ARB and diuretics, a protective effect of ACEi/ARB, and an increased risk with diuretics were observed. Similar results were obtained in alternative models, after adjusting for systolic and diastolic blood pressure at enrolment, diagnosis of hypertension, concurrent treatment with ß-blockers or calcium-channel blockers, and number of antihypertensive medications. CONCLUSIONS: Diuretics seem to be associated with a higher incidence of diabetes, whereas treatment with ACEi/ARB could have a protective effect.

Fungos veiculados por sementes comerciais de braquiária / Fungi associated to commercial seed of braquiaria grass

Este trabalho objetivou avaliar a qualidade sanitária de 50 lotes comerciais de sementes de braquiária, produzidos em diferentes regiões nas safras de 2004-2005 e 2005-2006. Sementes de Brachiaria brizantha cvs. Marandu e Xaraés, B. decumbens cv. Basilisk, B. humidicola cv. Humidicola e B. ruziziensis cv. Ruziziensis, destinadas ao comércio interno, foram submetidas ao teste de sanidade pelo método de papel de filtro. Adicionalmente, avaliou-se a sanidade de sementes de 'Marandu' (2 lotes) e 'Basilisk' (1 lote) destinadas à exportação. As sementes foram distribuídas sobre papel de filtro acondicionado em gerbox e incubadas a 20º C, com fotoperíodo de 12h, durante sete dias. Os fungos secundários ou de armazenamento (FSA) mais frequentemente detectados nos lotes de braquiária foram Aspergillus sp. e Rhizopus sp. Quanto aos fungos potencialmente patogênicos (FP), constatou-se elevada frequência dos gêneros Bipolaris. Curvularia. Fusarium e Phoma. Em geral, foi elevada a incidência de Bipolaris sp., Fusarium sp. e Phoma sp. nas sementes. A ocorrência de Phoma sp. foi crítica, pois 42% dos lotes registraram índices superiores a 70%. Bipolaris sp., Fusarium sp. e Phoma sp. também foram associados às sementes de braquiária tipo exportação, em alguns casos, com incidência considerável. Os resultados revelaram que as sementes comerciais de braquiária apresentam baixa qualidade sanitária e que, em todas as regiões produtoras, existe pelo menos um fator afetando a sanidade dessas sementes.

This work aimed to evaluate the sanitary quality of 50 commercial lots of seeds of braquiaria grass, produced in different regions in the crop of 2004­2005 and 2005­2006. The lots consisted of seeds of the cultivars Brachiaria brizantha cvs. Marandu and Xaraes, B. decumbens cv. Basilisk, B. humidicola cv. Humidicola and B. ruziziensis cv. Ruziziensis. Additionally, seeds of 'Marandu' (2 lots) and 'Basilisk' (1 lot) for exportation were analyzed. The blotter test was used, at 20º C under alternating light and darkness in a 12h photoperiod, for 7 days. Aspergillus sp. and Rhizopus sp. were the secondary or storage fungi with greatest frequency in lots of seeds. High frequency of potential pathogenic fungi, specifically of the Bipolaris. Curvularia. Fusarium and Phoma genera, was observed. In general, there was a high incidence of Bipolaris sp., Fusarium sp. and Phoma sp. in braquiaria grass seeds. The occurrence of Phoma sp. was severe, because 42% of the lots showed incidence superior to 70%. Bipolaris sp., Fusarium sp. and Phoma sp. were associated to braquiaria grass seeds for exportation, in some cases, with significant incidence. The results evidenced the low sanitary quality of commercial seeds of braquiaria grass, and demonstrated that in all producer regions there is at least one factor affecting the sanitary quality of these seeds.

[Results and development in cancer screening programs]. / Risultati e sviluppi dei programmi di screening oncologici.

In order to contribute to the definition of good model for cancer screening programs, the paper reports an overview of Veneto Local Health Units' results according to required "gold standard" defined by the authors. The analysis was based on a standard attesting that the program is running stabely and a standard for the organisation requiring that general management is performed by a unique central unit, supplied with a unique software and a working group equipped with specific know-how. Ten of the 21 Locale Health Unit of Veneto Region chose to assign to Prevention Department (Public Health Department) all the three screening programs included in the National Prevention Plan. Among these we found the two achieving the defined gold standard (Thiene and Pieve di Soligo). Management model implemented in these units showed a framework for excellence.

Ruptured chordae tendineae of the posterior leaflet of the tricuspid valve as a cause of tricuspid regurgitation following blunt chest trauma.

A 12-year-old boy suffered a blunt chest trauma. Some hours later, a pulsatile bilateral jugular venous distension, a holosystolic murmur heard at the low parasternal border and hepatomegaly were observed. On echocardiography, ruptured chordae tendineae of the posterior leaflet of the tricuspid valve, as well as tricuspid regurgitation were detected. He remained asymptomatic during hospital stay and was discharged home in good condition. Thus, isolated ruptured chordae tendineae of the posterior leaflet of the tricuspid valve is another cause of tricuspid regurgitation following blunt chest trauma.

Trypanosoma cruzi parasitemia observed in immunocompromised patients: the importance of the artificial xenodiagnosis.

Trypanosoma cruzi parasitemia observed in immunocompromised patients (transplant or positive HIV) occurred more frequently by the artificial xenodiagnosis method (10/38) compared with hemoculture (2/38), given the same quantity of blood. Other ways of diagnosis, like mice inoculation (5/38), QBC and buffy coat (2/38), were evaluated also. This result showed the importance of the artificial xenodiagnosis. The other techniques increased only one more patient positive.

[Extensive cardiac angiosarcoma in the course of immunosuppressive therapy after kidney transplant]. / Esteso angiosarcoma cardiaco in corso di terapia immunosoppressiva post-trapianto renale.

We present a case of a 49-year-old man who underwent a kidney transplant. Treatment with azathioprine and steroid was increased due to an initial rejection of the allograft. Six months later, the patient experienced palpitations and precordial pain: the electrocardiogram recorded atrial fibrillation and the echocardiogram showed moderate pericardial effusion and the presence of a right atrial mass with infiltration into the interatrial septum and right ventricle. Computed tomography imaging confirmed the tumoral mass and magnetic resonance imaging revealed the extensive involvement of the right atrium, right ventricle and superior vena cava, suggesting the presence of an angiosarcoma of the heart. Despite chemotherapy the patient died within 1 month. The diagnosis was confirmed by autopsy, histological section, and electron microscopy examination.

[An attempt to detect Trypanosoma cruzi in the peripheral blood of patients with Chagas' disease, in chronic phase, using quantitative buffy coat (QBC)]. / Tentativa de evidenciar o Trypanosoma cruzi no sangue periférico de pacientes com doença de Chagas, em fase crônica, por meio do Quantitative Buffy coat (QBC).

Taking for granted the sensitivity of the Quantitative Buffy Coat (QBC) system, as documented in a murine experimental model, we assayed to detect Trypanosoma cruzi in the peripheral blood of 100 patients with Chagas disease in its chronic phase. By means of the method, no positivity occurred, evently as a consequence of small parasitemias, undetectable by this technique as assessed by the cases in consideration.

Tentativa de evidenciar o Trypanosoma cruzi no sangue periférico de pacientes com doença de Chagas, em fase crônica, por meio do Quantitative Buffy coat (QBC) / An attempt to detect Trypanosoma cruzi in the peripheral blood of patients with Chagas' disease, in chronic phase, using quantitative buffy coat (QBC)

Taking for granted the sensitivity of the Quantitative Buffy Coat (QBC) system, as documented in a murine experimental model, we assayed to detect Trypanosoma cruzi in the peripheral blood of 100 patients with Chagas disease in its chronic phase. By means of the method, no positivity occurred, evently as a consequence of small parasitemias, undetectable by this technique as assessed by the cases in consideration.

Valorizando a sensibilidade do sistema Quantitative Buffy Coat (QBC), documentada em modelo experimental murino, estando os animais com infecção aguda pelo Trypanosoma cruzi houve tentativa de evidenciar esse parasita no sangue periférico de 100 pacientes com doença de Chagas, em fase crônica. Com o emprego desse método, nenhuma positividade ocorreu, evidentemente em virtude das pequenas parasitemias, não reveláveis pela técnica, pelo menos conforme o verificado através da casuística considerada.

[Lymphadenopathy caused by Toxoplasma in an intramammary lymph node: role of molecular biology in the diagnosis]. / Linfoadenopatia da Toxoplasma in linfonodo intramammario: ruolo della biologia molecolare nella diagnosi.

We describe a case of Toxoplasma gondii lymphoadenopathy in an intramammary lymph node in a 22 year old woman. Clinical evidence and ultrasound were suggestive for fibroadenoma, while cytology on fine needle aspiration suspected a lymphomatous lesion. The pathological examination demonstrated a lymph node with granulomatous foci with epithelioid histiocytes, consistent with Toxoplasma gondii lymphadenopathy. The pathological finding was confirmed by serological tests and by PCR (Polymerase Chain Reaction) using specific primers designed on ribosomal 18s DNA sequence of Toxoplasma gondii. The aim of this work is to emphasize the role of molecular biology techniques as an aid to pathological diagnosis in parasite diseases.

[Evaluation of the possible influence of Montenegro's intradermal reaction on a serological assay for the diagnosis of American cutaneous leishmaniasis]. / Avaliação de eventual influência da intradermorreação de Montenegro sobre prova sorológica para o diagnóstico da Leishmaniose tegumentar americana.

Influence of Montenegro skin test for American tegumentar leishmaniasis was evaluated to verify possible interference in serological diagnosis for this disease, performed by immunoenzymatic assay (ELISA). If this interference could occur, it would hamper scientific, epidemiological and patient care; happily we did not find any interference on serological diagnosis by performance of skin testing.