Cesare Tomasi

Prevalence of comorbidities and associated cardiac diseases in patients with valve aortic stenosis. Potential implications for the decision-making process

OBJECTIVES Aortic valve replacement (AVR) is recommended in patients with symptomatic aortic stenosis (AS). However a large number of elderly patients remain untreated because of a high operative risk. The aim of this study was to assess the risk profile of a group of AS patients, evaluating the prevalence of comorbidities and associated cardiac diseases and their impact on therapeutic decisions. METHODS Two-hundred forty consecutive AS patients underwent complete clinical evaluation, in order to define the stenosis severity, the prevalence of several associated cardiac conditions and comorbidities. Furthermore, the treatment choices based on this approach were recorded. RESULTS Mean age was 78.6 ± 8.93 years, 75.5% was ≥ 75 years old, 60% females; 226 patients (94.2%) had symptoms and 54.2% was in NYHA classes III-IV. Valve area <1cm(2) was detected in 81.6% of patients. Both comorbidities and associated cardiac diseases were common; particularly, renal dysfunction was detected by estimated glomerular filtration rate in 52.7%, chronic obstructive lung disease in 25.4%, cerebrovascular/peripheral artery disease in 30.8% and 11.6%, respectively, diabetes in 30%, malignancies (current or previous) in 26.6% of patients. Among associated cardiac diseases, coronary artery disease was detected in 43.7%, LV systolic dysfunction in 28.7%, pulmonary hypertension in 67%, at least moderate mitral regurgitation in 32.5% and porcelain aorta in 7.5% of patients. Fourteen asymptomatic patients (pts) (5.9%) remained in follow-up, 77 (32%) underwent surgical AVR, 64 (26.7%) underwent transcatheter valve implantation, 28 (11.6%) underwent balloon valvuloplasty and 57 (23.8%), despite symptoms, remained on medical therapy alone. CONCLUSIONS Comorbidities and coexisting cardiac diseases are very common in AS and may strongly influence the decision-making process.

The 'real' woman with heart failure. Impact of sex on current in-hospital management of heart failure by cardiologists and internists

To identify differences between sexes in the clinical profile, use of resources, management and outcome in a large population of ‘real world’ patients with heart failure (HF).

Evaluation of different methods to determine total serum lipids for normalization of circulating organochlorine compounds

ObjectivesSerum levels of persistent organochlorine compounds may be predictive of their body burden, if adjusted by total serum lipids. Their value may be predicted by three different formulae, requiring only values of serum cholesterol and triglycerides. The study was aimed at: (i) evaluating the validity of these formulae; (ii) evaluating the influence of different estimates on serum levels of lipid adjusted persistent organochlorine compounds.MethodsWe determined the levels of cholesterol, triglycerides and phospholipids by enzymatic assays on serum samples from 121 subjects living in a polluted area of Northern Italy. On the same samples and on an additional set from 69 pregnant women of the same area, we determined also polychlorinated biphenyls, hexachlorobenzene and p,p′-dichlorodiphenyldichloroethylene. In women, analytes were determined also on adipose tissue samples.ResultsFormulae provided results comparable to those obtained as sum of cholesterol, triglycerides and phospholipids. In women, we found highly significant relationships among lipid adjusted pollutant levels in serum and adipose tissue, independently from the used formula.ConclusionsFormulae allow a valid adjustment of organochlorine compounds in serum. The algorithm proposed by Phillips et al. provides some slight advantage over the others, in terms of simplicity of use.

Occupational exposure to polychlorinated biphenyls and risk of cutaneous melanoma: a meta-analysis.

The aim of this study was to carry out a meta-analysis of studies on exposure to polychlorinated biphenyls (PCBs) and the risk of malignant melanoma (MM). We searched Scopus, PubMed, and reference lists; among 807 potentially relevant articles, we selected those based on 12 populations. Data were extracted according to a standardized form; the Newcastle–Ottawa Scale was used to assess study quality. Meta-analyses were carried out according to fixed-effect and random-effects models. The fixed-effect summary relative risk (RR) for MM was 0.91 [95% confidence interval (CI): 0.82–1.00]; the random-effects summary RR was 1.05 (95% CI: 0.78–1.32). The random-effects summary RR from eight occupational cohorts was 1.13 (95% CI: 0.91–1.35) and that from four community-based studies was 0.84 (95% CI: 0.36–1.31). The quality of the studies and the methods for PCB exposure assessment did not influence the RR. These results do not support the hypothesis of an association between PCB exposure and the risk of MM.

Lack of correlation between blood lead and serum prolactin levels among lead exposed workers

A cross sectional case (241 males occupationally exposed to lead)–control (102 males unexposed to lead) study was performed with the aim of evaluating the relationship between serum prolactin (S-PRL) and lead blood (PbB) levels. A meta-analysis of S-PRL levels in similar studies was also carried out. No difference of S-PRL between groups or any relationship between PbB and S-PRL levels was found. The meta-analysis showed a slight increase of S-PRL levels among exposed people, the weighted means falling within the reference values of the biomarker. The results do not support a routine use of S-PRL as a biomarker of effect in lead exposed workers.

Environmental and biological monitoring of occupational exposure to polynuclear aromatic hydrocarbons during highway pavement construction in Italy

OBJECTIVES We performed a cross-sectional study with the main aim of evaluating occupational exposure to polycyclic aromatic hydrocarbons (PAHs) in workers involved in the pavement construction of a new highway in Northern Italy, where modified bitumen was used as binder for Hot Mix Asphalt. METHODS We applied a combined approach of air and biological monitoring. Both the aerosol and vapour phases of bitumen were collected applying the NIOSH 5506 method. The 16 PAHs listed as high priority by EPA were determined by HPLC-UV. End-of-shift urine samples were collected from 144 workers to determine 1-hydroxypyrene (1-OHP) and 2-naphthol (2-NAP) concentrations after enzyme digestion and HPLC-UV analysis. Socio-demographic and lifestyle information was collected by a questionnaire. RESULTS Paving workers were actually exposed to PAHs, including carcinogenic compounds, that were measurable only in the aerosol phase. Higher exposure as well as dose levels were measured for the paver group. Biological monitoring confirmed that 1-OHP was less affected by smoking habits as compared to 2-NAP and showed a higher association with occupational exposure. CONCLUSION Carcinogenic PAH compounds were detectable only in the aerosol phase and this must be taken into account in the adoption of preventive measures. Biomonitoring supported the superiority of 1-OHP as compared to 2-NAP in assessing the internal dose in such workers.