Emanuele Cannizzaro

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is becoming the most common liver disease, affecting between 30 and 40% of the global population. MASLD is a multifaceted disease spectrum that is closely associated with obesity, insulin resistance, type 2 diabetes mellitus and, more broadly, metabolic syndrome. All these conditions increase the risk of liver-related mortality, which explains the intense research efforts in recent years to better elucidate its pathogenesis. The crucial impact of environmental pollutants on the development of MASLD is now well recognized. Polychlorinated biphenyls (PCBs) are environmental contaminants that act as endocrine disruptors. Recently, they have been associated with the development of diabetes, obesity, MASLD, and cancer. The association between liver diseases, namely toxicant-associated steatotic liver disease and steatohepatitis (TASLD and TASH, respectively), and occupational exposure to PCBs and other industrial chemicals has been documented by several lines of evidence, whereas the potential role of low-level environmental pollution in liver disease and in MASLD remains incompletely understood. Previous studies on animal models have shown that PCB exposure is associated with steatosis/steatohepatitis, fibrosis, cirrhosis, hepatocellular carcinoma (HCC), altered liver enzymes, and mortality in exposed populations. This review investigates the mechanisms underlying hepatic steatogenesis in preclinical and animal models and analyzes the existing literature on the possible role of PCBs, together with the other conventional risk factors, in the development of MASLD in humans.

Indoor air pollution (IAP) has emerged as a critical yet underrecognized threat to public health, particularly in non-industrial environments such as homes, schools, and healthcare facilities. As individuals spend approximately 90% of their time indoors, exposure to indoor pollutants—such as particulate matter, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), and microbial contaminants—can lead to significant health risks. These risks disproportionately affect vulnerable populations, including children, the elderly, and individuals with pre-existing conditions. The effects range from mild respiratory symptoms to severe outcomes like asthma, cardiovascular diseases, and cancer. This review investigates the sources, typologies, and health effects of indoor air pollutants, with a focus on their implications for maternal and child health. In particular, children’s developing systems and higher metabolic intake make them more susceptible to airborne toxins. The study also explores the legal and regulatory frameworks surrounding indoor air quality (IAQ), emphasizing how increased awareness and scientific evidence are expanding the scope of medical–legal responsibility. Legal liabilities may arise for property owners, designers, or manufacturers when poor IAQ leads to demonstrable health outcomes. Despite growing concern, there remains a significant research gap concerning the long-term health effects of chronic low-level exposure in residential settings and the efficacy of mitigation strategies. The evolution of smart building technologies and green construction practices offers promising avenues to improve IAQ while maintaining energy efficiency. However, standards and regulations often lag behind scientific findings, highlighting the need for updated, enforceable policies that prioritize human health. This work underscores the urgency of a multidisciplinary and preventive approach to IAQ, integrating public health, environmental engineering, and legal perspectives. Future research should focus on real-time IAQ monitoring, targeted interventions for high-risk populations, and the development of comprehensive legal frameworks to ensure accountability and promote healthier indoor environments.

Background: The prevalence of obesity and sleep disorders within the Italian workforce mirrors a global trend where sedentary lifestyles, poor eating habits, and elevated stress levels significantly contribute to these health issues. These conditions have profound economic implications, including rising healthcare costs and diminished productivity due to absenteeism and presenteeism, adversely affecting organizational sustainability and employee well-being. Addressing these problems necessitates a holistic approach that integrates individual health interventions, workplace policies, and broader societal changes to promote healthy lifestyles. This cross-sectional study examines the influence of obesity and insomnia, both individually and combined, on work productivity within the context of occupational health and sustainability. Materials and Methods: A cross-sectional analysis was conducted with 397 participants from various professions over a six-month period. Self-reported work productivity impairments were assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire. Body Mass Index (BMI) and Insomnia Severity Index (ISI) scores were utilized to evaluate obesity and insomnia levels, respectively. Results: Statistical analyses revealed a significant association of higher BMI and ISI scores with reduced work productivity. Both obesity and insomnia independently and synergistically contributed to productivity losses, with obesity exerting a more substantial effect. These findings indicate that obesity and insomnia increase presenteeism, thereby negatively impacting organizational performance and workplace sustainability. Conclusions: Our study underscores the critical impact of obesity and insomnia on work productivity and highlights the necessity of addressing these health issues not only for individual well-being but also for organizational sustainability. Integrating targeted health management strategies within workplaces to address these conditions can enhance productivity, improve employee well-being, and promote occupational health and safety. These interventions align with the current concept of sustainable work and are essential steps toward achieving sustainability in the workplace.

Background/Objectives: The respiratory system is prone to infectious diseases, especially in children below five years of age. Upper respiratory tract infections in children are often associated with Eustachian tube dysfunction and complicated by otitis media with effusion (OME), an inflammatory process within the middle ear, which can lead to hearing loss. Treatment for these infections involves a combination of medication and symptom relief, depending on the severity and cause of the infection. In recent years, natural therapeutic drugs derived from herbal medicines have been gaining popularity in treating various pathologies. Bromelain, one of the most studied natural compounds, has been investigated extensively due to its numerous pharmacological properties, offering a potential new avenue for treatment. Based on these promising findings, our study was designed to examine the efficacy of supplementation with bromelain in countering symptoms associated with OME. Methods: This study was conducted on data acquired from medical records from the Section of Audiology of the University of Palermo, focusing on the period of January 2022 to June 2023 and selecting 224 children (age range 1–8 years), namely 174 males and 50 females, who were evaluated for presumed OME at the audiology pediatric ambulatory. All patients selected before initiating pharmacological treatment underwent thorough screening regarding the functionality of the tympanic cavities, otoacoustic emissions, the auditory threshold, and the ear canal’s integrity. Results: The preliminary findings of this study are significant, demonstrating that supplementation with bromelain led to notable improvements in the symptoms accompanying OME after 15 days and 60 days of therapy. Notably, patients who received the bromelain supplement reported reduced mucus secretions and improved auditory function. Conclusions: These results underscore the potential of naturally occurring compounds as adjuvants to standard therapeutic strategies in treating OME.

Asbestosis is an interstitial lung disease caused by the inhalation of asbestos fibers and poses a significant risk to individuals working in construction, shipping, mining, and related industries. In a forensic context, postmortem investigations are crucial for accurate diagnosis, for which the gold standard is the histopathological examination. This case report describes the autopsy and related investigations conducted on an 84-year-old man, nearly one year (357 days) after his death. After a post-mortem CT scan, an autoptic investigation was performed, followed by histopathological, immunohistochemical, and scanning electron microscopy examinations. The integration of the evidence from these examinations with previously available personal and clinical information conclusively confirmed the diagnosis of asbestosis. We demonstrated the efficacy and reliability of our diagnostic protocol in detecting asbestosis and asbestos fibers and excluding mesothelioma even in decomposed tissues. According to our findings autopsy remains the diagnostic gold standard in cases of suspected asbestosis within a forensic context, even 1 year after death, therefore it is always highly recommended, even in cases where the body has decomposed.

In the context of sustainable development, the occupational sphere must be integrally considered within health promotion frameworks, ensuring an equitable work–life balance while recognizing and amplifying the capabilities of every employee. Concurrently, there is a notable trend of physicians transitioning from public to private healthcare sectors, with burnout frequently cited in scholarly discourse as a primary catalyst for this shift. The objective of our study was to examine the vulnerability of medical staff to burnout. To achieve this, we conducted a cross-sectional analysis involving 1084 physicians from various specialties, employed in urban hospital settings. This research was executed via the distribution of an anonymous questionnaire, utilizing the Google Forms platform during work hours. The questionnaire was based on the Maslach Burnout Inventory (MBI) scale, specifically adapted for medical professionals, requiring respondents to provide insights into their experiences. Analysis of the collected data from a total of 614 respondents indicated a moderate predisposition towards burnout among the sample. These findings underscore the necessity for interventions targeting organizational flexibility and, notably, the restructuring of remuneration practices. Salaries often do not reflect the terms of employment contracts across numerous EU jurisdictions, necessitating urgent reforms. In conclusion, the reinforcement of interpersonal dynamics within medical teams and between healthcare institutions and their practitioners emerges as a critical strategy. Enhancing these relationships is essential for revitalizing the healthcare delivery system, ensuring that medical professionals are adequately compensated in alignment with the principles of sustainable employment.

In the context of sustainable development, integrating the work aspect into health promotion systems is essential, ensuring that employees maintain a healthy balance between their professional and personal lives, which respects and amplifies the potential of every individual. Lately, there has been a noticeable shift of medical professionals from the public to the private sector. This trend paints a bleak picture, highlighting the vulnerabilities of a system teetering on the brink of failure, with significant impacts on patient care. Among the myriad reasons behind this shift, burnout stands out prominently. Medical professionals face increasing pressures due to understaffing, limited organizational support, and insufficient resources, leading to feelings of cynicism, exhaustion, and detachment from their roles. Utilizing the Maslach et al. questionnaire, we assessed the risk of burnout among physicians in public hospitals to identify and underscore preventive measures and improvements, correlating our findings with key aspects of organizational empowerment. Our research indicates that enhancing interpersonal relationships and resources—both within teams and between the organization and its physicians—is crucial for the revival of the healthcare system. This approach aims at improving the delivery of healthcare services and offering appropriate recognition to healthcare professionals, aligning with the principles of sustainable employment.