Characterization of nitrogen dioxide variability using ground-based and satellite remote sensing and in situ measurements in the Tiber valley (Lazio, Italy)

The spatial-temporal distributions of nitrogen dioxide (NO2) in a rural area of Tiber valley were evaluated over one year (March 2022-February 2023) using remote sensing and in situ measurements. Surface concentration monitoring was conducted using a Pandora-2s spectrometer and a chemiluminescence analyzer operated at the Liberti Observatory (CNR-IIA). In spring, when the growing season and the agricultural activities increase, NO2 peaks were detectable by the Pandora but not by the in situ analyzer. The tropospheric Pandora and TROPOMI VCD products showed similar temporal patterns as those of the analyzer at the Observatory. High TROPOMI VCD levels in spring were detected at the Observatory and at six sites selected as representative of rural, residential, and industrial environments. WRF simulations found that high pollution events, observed by the Pandora and analyzer, occurred in calm wind conditions, favouring the accumulation of NO2 locally emitted. The complementary dataset provided by remote sensing and in situ techniques efficiently captured the spatial-temporal NO2 variability in a rural site exposed to low emission sources, thus supporting future decisional policies and actions

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Metabolic profiling and stress response of anaerobic and respiratory cultures of Lactobacillus plantarum C17 grown in a chemically defined medium

We investigated the effect of anaerobic (AN) and respiratory conditions (RS; oxygen, hemin and menaquinone) on the growth, enzymatic activities (POX, NOX, NPR), metabolic profile (1H-NMR spectroscopy), and response to oxidative (catalase, tolerance of H2O2) and heat stresses of Lactobacillus plantarum C17 (wild-type) and its natural oxidative stress-tolerant mutant C17-m58, using chemostat cultivation in a modified chemically defined medium (mCDM). Respiratory growth impaired biomass production and tolerance of heat stress in mCDM compared with cultivation in the complex Weissella medium broth (WMB). POX activity, oxygen consumption, and H2O2 tolerance were higher in respiratory cells and in C17-m58. Significant amounts of formate and acetate were found in AN cultures of wild-type and mutant strains, confirming the activation of an anaerobic pyruvate formate lyase–acetate kinase (PFL-ACK) pathway in L. plantarum. The presence of succinate supports the presence of an incomplete TCA cycle in this species. High concentrations of pyruvate were measured in RS supernatants, indicating reduced functionality of POX in vivo (35 °C) and the need to clarify the regulation and control of oxygen metabolism. Adipate was found in respiratory samples, likely because of lipid peroxidation, and its production by respiring lactic acid bacteria may be investigated and exploited for biotechnological uses

Nitrogen Oxides (NOx) in the Arctic Troposphere at Ny-Ålesund (Svalbard Islands): Effects of Anthropogenic Pollution Sources

Atmospheric measurements of nitrogen oxides (NOx = NO + NO2), ozone (O3) and other constituents were carried out during three field campaigns (29 March–30 April 2010, 1–26 April 2011, 18 May–8 October 2015) at Ny-Ålesund. The study focused on the variability of important O3 precursors, such as NOx, in the Arctic troposphere, and on the impact from anthropogenic sources on their measured concentrations: higher NO and NO2 levels were mostly associated with the lowest wind speeds and northern directions, indicating local pollution. Long-range transported sources from Russia and Europe were also identified with an occurrence of high NOx levels. Several ozone depletion events were observed and associated to winds blowing from the north-west direction (Arctic Ocean). Most of these events were connected to the lower NO and NO2 concentrations. Measurements of halogen and low molecular weight carbonyl compounds in 2010 and 2011, respectively, showed variable effects during the ozone depletion events. Other data, such as high time-resolved radon progeny measurements, were used in 2015 to identify source tracking and transport of air masses, local effects and atmospheric stability dynamics that could influence the NOx concentrations at Ny-Ålesund

Artrite settica dell\u2019anca in epoca neonatale: una sfida diagnostica

INTRODUZIONE: L\u2019artrite settica dell\u2019anca \ue8 una condizione piuttosto rara in et\ue0 pediatrica che pu\uf2 svilupparsi in seguito a diffusione ematogena, estensione flogistica da sito adiacente e/o inoculazione microbiologica diretta. CASO CLINICO: Descriviamo il caso di un neonato di 6 giorni di vita giunto alla nostra attenzione per comparsa improvvisa di irritabilit\ue0 e ipomotilit\ue0 degli arti inferiori. Nato a termine, da parto eutocico, in gravidanza normodecorsa, con tamponi vaginali sconosciuti. Peso neonatale ed indice di Apgar nella norma. Periodo perinatale regolare; lieve instabilit\ue0 dell\u2019anca destra alla manovra di Ortolani-Barlow. Alla Ia valutazione in PS il piccolo si presentava apiretico, vivace e reattivo, con parametri vitali nella norma. L\u2019anca destra appariva flessa, extra-ruotata e dolente alla mobilizzazione passiva ed attiva. L\u2019emocromo e il dosaggio degli indici di flogosi non risultavano dirimenti e all\u2019Rx degli arti inferiori non si evidenziavano rime di frattura. Per il riscontro all\u2019ecografia delle anche di versamento intra-articolare veniva avviata terapia antibiotica endovenosa ad ampio spettro (con amikacina e ceftazidime). La RMN, eseguita in seguito, confermava la presenza di coxite destra, con interessamento capsulare, e poneva indicazione a drenaggio eco-guidato. La coltura del liquido sinoviale rivelava la crescita di S. epidermidis. Nella settimana successiva si assisteva ad un netto miglioramento delle condizioni cliniche con concomitante risoluzione ecografica del versamento articolare. La terapia antibiotica veniva, quindi, proseguita a domicilio per un totale di 10 giorni in assenza di sequele a distanza. CONCLUSIONI: Una diagnosi precoce (basata sui criteri di Morrey) ed un trattamento tempestivo (con antibiotici permette la risoluzione dell'artrite settica in et\ue0 pediatrica