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Biomedical subjects

A Grieco

Publications and source records attributed to A Grieco.

At least 127 records · Page 7Linked to original sources

Exposure assessment of upper limb repetitive movements: a consensus document developed by the Technical Committee on Musculoskeletal Disorders of International Ergonomics Association (IEA) endorsed by International Commission on Occupational Health (ICOH).

This consensus document intends to supply a set of definitions, criteria and procedures useful to describe and, wherever possible, to assess the work conditions that can represent a physical overload for the upper limbs. The document is aimed at all the operators, i.e. occupational doctors but mainly technicians, who are, involved in risk exposure assessment and management. The document intends to provide methods and procedures easily applicable in the field, possibly not requiring sophisticated instrumentation and when possible based on observation procedures. The proposed methods shall be based as far as possible on knowledge and data from scientific literature: should they be contradictory or deficient, reference will be made to standards or pre-standards issued by national and international agencies and bodies, with the experience of researchers involved and common sense. In this regard, it is to be emphasized that the potential users increasingly demand an easily applicable method for description and assessment of work with repetitive movements. The group intends to give a response even if there are still uncertainties from a strictly scientific standpoint: however the group commits itself to perform subsequent validations especially of as yet unconsolidated issues. This document focuses specifically on identification of risk factors and describes some of the methods that have been developed for evaluating them. There is a rapidly developing body of literature on job analysis and not yet agreement on a single best way to analyze jobs. Professional judgement is required to select the appropriate methods. Analysis and design of jobs should to be integrated into an ongoing ergonomics program that includes management commitment, training, health surveillance, and medical case management. In summing up this report, space must be given to the check lists that are so often seen in the medical press, although this is not the occasion to propose a detailed analytical review.

Arm↗

[The centenary of the founding of the "Clinica del Lavoro Luigi Devoto" in Milan (1902-2002). The oldest health organization in the world for the study, treatment, and prevention of occupational diseases].

The foundation of the Clinica del Lavoro by Luigi Devoto cannot be dated back to the specific date of an event or, worse, to the official inauguration as has happened so far. It can rather be considered as a process started on November 20, 1902 (date of the first resolution by the Milan Municipality Council), continuing with the national law n. 365 of July 9, 1905, then with the laying of the first stone on December 11, 1907 bearing the motto of the Milanese School "In aliis vivimus, movemur et sumus" and finally the official inauguration on March 20, 1910. The Founder Luigi Devoto was born in 1864 at Borzonasca (Genoa) and took a degree of medicine and surgery at the Genoa University in 1888. After a period in Prague and then in Genoa, he was appointed temporary teacher of medical pathology in Pavia. He published several scientific contributions in different fields of occupational health (lead intoxication, ankylostomiasis, strain cardiopathy, etc.) and in other branches (tuberculosis, pellagra, etc.) that he considered as indirectly work-related diseases. He died in Milan in 1936. Three issues characterize the ingenious intuition of Luigi Devoto and his thirty-year direction of the Clinica del Lavoro: 1. Full respect for the principles of discipline and scientific method suggested by Bernardino Ramazzini; 2. The extremely broad conception of the diseases that had to be considered as "workers' diseases"; 3. The constant social attention towards the application of scientific knowledge also through workers' information and updating of regulations to improve working conditions. Many of the conflicts and events associated with the foundation of the Clinica del Lavoro can be summarized in the name chosen by the Founder. Actually to those asking why "Clinic of Work" and not "Clinic of Workers", Devoto used to reply that it was work that was ill and therefore it was necessary to treat the work to prevent workers' illnesses.

Academies and Institutes↗

[Musculoskeletal conditions of the upper and lower limbs as an occupational disease: what kind and under what conditions. Consensus document of a national working-group. ISPESL].

BACKGROUND AND OBJECTIVES: In via of the progressive emergence in Italy of work-related musculoskeletal disorders, the EPM Research Unit decided to set up a national working group with the aim of producing a Consensus Document including methods and criteria as an initial attempt towards managing such diseases as true "listed" work-related diseases as is already done in the other European Union countries. The working group includes experts from INAIL, ISPESL, welfare assistance institutions, local prevention and health protection services: The group's research activity was included in ISPESL's funded research plan. CONTENTS: The Consensus Document includes a review of epidemiologic issues reported in the international literature, comments on the application of current legislation, observations on the guilt profiles of employers and occupational physicians, as well as medical-legal issues. The document proposes an analytical list of musculoskeletal disorders of upper (and lower) limbs and the operational criteria for identification of working activities involving a risk from upper limb biomechanical overload. In this case, more than on other occasions, it was realized how difficult it is to adopt consolidated task/risk/damage matrices since the same task may or may not be at risk depending both on the way the task is done and on the technical aspects (lines, work parts, procedures, tools) and organization (rate, rotas, breaks). CONCLUSIONS: For the specific aims of the present document, it is possible to identify, though not exhaustively and with some limitations, a series of jobs and working conditions where the risk may be reasonably presumed and for which it is possible to adopt a list system (at least as regards "significant exposure"). The document also includes a chapter on health surveillance recommendations for the occupational physician.

Adult↗

Humoral immune response against hepatitis C virus.

Antibodies are in several instances a reliable marker indicating vigorous immune response against infectious agents and in several viral diseases presence in the blood of specific anti-viral antibodies indicates an effective protection. However, this is not always true. For example, in the case of hepatitis C virus (HCV) an important human pathogen considered the causative agent of the nonA- nonB hepatitis, in spite of an intense antibody response there is no protection against a new infection and in the majority of infected individuals the virus overcomes host defences establishing a persistent infection. Here we describe how the dissection of the humoral immune response against HCV glycoprotein E2 of infected patients was useful for a better comprehension of the virus-host interplay. Cross-reactive antibodies directed against E2 are produced by the HCV-infected patient, but not all of them are protective, and some could even result to be detrimental for the patient. The cross-reactive anti-HCV/E2 humoral antibody response is complex and not necessarily completely beneficial to the host.

Antibody Formation↗

Heterogeneity of the humoral anti-HCV/E2 response in persistently infected patients as demonstrated by divergent patterns of inhibition of the binding of anti-HCV/E2 human monoclonal antibodies.

A complete understanding of the molecular features of humoral immune response could be of pivotal importance in the management of persistent viruses as HCV. In this study, 24 HCV-positive samples, characterized by classical virological parameters, are evaluated using a new assay for the quantitation of antibody subpopulations directed against discrete epitopes on surface glycoprotein E2, a key viral protein. The results, besides confirming the usefulness of this new approach, highlight the extreme heterogeneity of anti-HCV/E2 response as far as single epitopes are concerned. The specific epitopes under study are also demonstrated to be widely shared among different genotypes.

Antibodies, Monoclonal↗

[Project of the historical monograph on the "Origins of Occupational Medicine Associations in the world"].

The present contribution regards the project of the historical monograph on the Origins of OH associations in 23 countries, and in particular the chapter on the Origins of the Italian Society of Occupational Health. The Italian chapter is aimed at studying the foundation of the Italian Society of Occupational Health (Naples, October 12, 1929, within the 8th National Congress of Occupational Health) and the first decades of its activity. On account of the complexity and variety of the scientific and social context as well as the particular political period considered, the contribution is divided into 4 different parts. The first deals with the foundation of the Italian Society of Occupational Health and its statutory organization. The second part treats the role and presence of the discipline in the university world as well as the relationships with other cultural institutions such as academies. The third part concerns the law frame (specially as to accidents and work-related diseases) within which the activity of the Italian Society of Occupational Health has started and developed. The fourth part analyses the fascist corporative system and the role played by the trade unions in promoting better life and working conditions, with common issues also with the programmes of the Italian Society of Occupational Health. Finally, some closing remarks and references are provided.

Internationality↗

13C-breath tests in the study of mitochondrial liver function.

Breath tests for "dynamic" liver function evaluation have been proposed several years ago. A variety of carbon-labelled breath tests for the assessment of mitochondrial, microsomal and cytosolic liver function have been described with the aim to increase data on liver disease staging, prognosis, and response to therapy. In the last years a great interest is developed about the use of breath test for liver mitochondrial function evaluation since it results impaired in a wide range of liver diseases either of genetic or acquired origin. In these cases mitochondrial oxidative metabolism of some substrates, as far as recovery of the hepatic energy state after a metabolic insult, results impaired because of the disfunction of the electron transport chain and/or ATP synthesis. Ketoisocaproic acid and methionine are the best studied carbon-labelled substrates for the investigation of mitochondrial functional damages related to structural alterations that occur in many liver diseases. Although these tests are simple, cost-effective and safe, to date there is still not general approval for their usefulness in clinical settings since they should fulfill several requirements to overcome the drawbacks of traditional quantitative tests. On the other hand, this field is relatively young and further studies are needed in order to assess the suitable substrate for the evaluation of the complex mitochondrial metabolism both in healthy subjects and in patients with liver disease.

Breath Tests↗

13C-breath tests in the study of microsomal liver function.

Conventional liver tests can be used to estimate a mixture of injury and function but none of these may be regarded as a reliable marker either to quantify functional hepatic reserve or to reflect life-threatening complications of acute and chronic liver diseases. To overcome this limit, many dynamic tests have been developed in order to evaluate the "hepatic functional mass". Among these tests we can include breath tests with 13C-labeled substrates undergoing different metabolic pathways. As concerning the evaluation of microsomal function, two main categories of breath tests have been developed based on the limiting step in the different substrates metabolism. The first group include aminopyrine, caffeine and diazepam, all substrates with a metabolism independent from hepatic blood flow and dependent almost exclusively from the enzymatic activity of different cytochromes P450. The other group is composed of substrates with flow dependent metabolism like methacetin, phenacetin, erythromycin. The aim of this review is to describe the clinical applications of microsomal liver breath tests in different hepatic diseases.

Acetamides↗

Nonalcoholic fatty liver disease: defining a common problem.

Non Alcoholic Fatty Liver Disease (NAFLD), with prevalence of 10-51% in general population involving all ages, is the major cause of elevation of ALT and a common finding by ultrasound screening and may range from simple steatosis, to Non Alcoholic Steatohepatitis (NASH) and its clinical consequences as cirrhosis and hepatocellular carcinoma. In this review will be analyse factors influencing the onset of the disease. NAFLD, primarly associated with insulin resistance, is in fact considered the hepatic manifestation of the metabolic syndrome: a cluster of disorder that includes obesity, diabetes mellitus, dyslipidaemia, arteriosclerosis and hypertension. The increased incidence and prevalence of obesity and diabetes may explain growing interest in NAFLD. Racial, ethnic, enviromental and behaviour models are also reviewed.

Alanine Transaminase↗

Nutritional aspects in patients with non-alcoholic steatohepatitis (NASH).

BACKGROUND AND OBJECTIVES: Metabolic alterations are a common feature in patients affected by non-alcoholic steato-hepatitis (NASH). A strong correlation exists between overweight, in particular visceral fat accumulation, and prevalence of NASH, especially in men. Thus, diet-induced weight loss represents a fundamental tool in disease management of these patients. The aim of the present study was to evaluate body composition and nutrient utilisation in patients with NASH, comparing them with patients affected by chronic hepatitis related to hepatitis C virus (HCV) infection and with healthy subjects. MATERIALS AND METHODS: Twenty male outpatients with NASH (age: 41 +/- 11 yr; BMI: 26.2 +/- 2.1 kg/m2) and 14 HCV male patients (age 44.6 +/- 13 yr; BMI: 24.8 +/- 2.8 kg/m2) were enrolled in the study. A group of 20 healthy male subjects (age: 39 +/- 10 yr; BMI: 23.3 +/- 1.1 kg/m2) were studied as controls. Body composition was assessed by anthropometry and dual-energy X-ray absorptiometry; resting metabolic rate and nutrient oxidation by indirect calorimetry. A 7-day food diary was collected. The main biochemical parameters were measured using standardised laboratory techniques. RESULTS: Body weight was higher in NASH patients with respect to HCV patients and control subjects (respectively 75.2 +/- 8.9 vs 68.5 +/- 9.4 and vs 67.0 +/- 8.0 kg; P < 0.01) and this was essentially due to fat mass increase. Fat-free mass reduction was found in HCV patients with respect to both NASH and control subjects. Patients with NASH had a significantly higher waist circumference (P < 0.01) and a lower resting metabolic rate (RMR) with respect to HCV and control subjects. Energy intake was significantly higher in NASH patients (P < 0.01) compared to the other two groups. CONCLUSIONS: NASH patients showed an increase in body weight, fat mass and visceral fat accumulation with respect to HCV and control subjects. The reduction in RMR, coupled with increase energy intake may explain the body composition alterations found in these patients.

Adult↗

Hepatic steatosis and vascular disease.

Nonalcoholic fatty liver disease (NAFLD) refers to a wide picture of liver damage, ranging from steatosis to steatohepatitis, fibrosis and cirrhosis. The epidemiological studies demonstrated an association of NAFLD with obesity, type 2 diabetes and hyperlipidemia. Under this light the metabolic syndrome (MS), including NAFLD, obesity, central fat distribution, diabetes, dyslipidemia, hypertension and atherosclerotic cardiovascular disease (CVD) can be considered the link to explain the presence of vascular diseases in patients with NAFLD. In NHANES III, the authors demonstrated that the presence of MS was associated with increased risk of myocardial infarction, stroke or both. In a prospective study on 1209 Finnish middle-aged men without CVD or diabetes at baseline, Lakka showed that MS per se is associated with an increased risk of CVD and all-cause mortality. Finally the Atherosclerosis Risk in Communities (ARIC) confirmed that subjects with MS were 2 times more likely to have prevalent coronary heart disease. From a pathophysiological point of view, growing evidences implicate the oxidative stress as the unifying mechanism for many CVD risk factors. Under this light there is emerging evidence suggesting that there is a significant increase in vascular oxidative stress in patients with MS, with the presence of endothelial dysfunction in the early stage of the syndrome. Indeed, the inflammation process evidentiated in these patients is initiated at the endothelial level, stressing the key role of this active and dynamic tissue in the pathophysiological pathways. Under this light the endothelium can be considered as the last effector of a multi-syndrome and the main target of all the future studies focused on the underlying mechamisms of this complex network. Because of the potential serious public health impact, the comprehension of these patophysiological pathways will be crucial to design new preventive measures and therapeutic strategies.

Animals↗

The natural history and risk factors for progression of non-alcoholic fatty liver disease and steatohepatitis.

Nonalcoholic fatty liver disease (NAFLD) is a condition of increasing incidence in western Countries seldom associated to other diseases of high prevalence in general population (i.e. diabetes and obesity). NAFLD ranges from simple fatty liver to steatohepatitis (NASH), which may lead to cryptogenic cirrhosis and in some cases hepatocellular carcinoma (HCC). Natural history of NAFLD in humans is poorly understood and progression of liver disease seems to be due to interaction between hosting (i.e. genetic, gut flora, insulin resistance) and environmental factors (social and eating behaviours) that should be responsible of increased oxidative stress within hepatocytes. Even if we need non-invasive markers able to describe the progression of liver disease, only meaning of liver biopsy is useful to characterize the stigmata of worsening such as inflammation and fibrosis.

Animals↗

Fatty liver and drugs.

Drug-induced liver diseases (DILD) are clinico-pathologic patterns of liver injury caused by drugs or other foreign compounds. Steatohepatitis is a rare form of DILD, and drugs account for fewer than 2% of non-alcoholic steatohepatitis (NASH). Drugs known to be capable of inducing steatosis and steatohepatitis can be divided into three broad groups: those that cause steatosis and steatohepatitis independently (e.g., amiodarone, perhexiline maleate); drugs which can precipitate latent NASH (e.g., tamoxifen); drugs whic duce sporadic events of steatosis/steatohepatitis (e.g., carbamazepine). Clinical DILD syndromes include acute viral hepatitis-like injury, acute liver failure, cholestatic hepatitis,liver disease with signs of hypersensitivity, autoimmune hepatitis-like injury, acute venous-Outflow obstruction, chronic cholestasis, ciirrhosis, steatosis and steatohepatitis. The clinical picture is by no means dependent on the mechanism of injury (direct hepatotoxicity, idiosyncratic reactions, hypersensitivity reactions). Reliable diagnosis of drug-induced liver disease requires demonstration of close correlation between the patient history and clinical, laboratory, and histological data.

Amiodarone↗