Stima del contributo al particolato ed agli IPA delle emissioni da traffico navale e da attività portuali nell’area di Brindisi

Obiettivo del lavoro è fornire una stima dell’impatto del traffico navale e delle relative attività portuali (arrivo/partenza/movimentazione e stazionamento di navi) sulla concentrazione di PM2.5, sulla concentrazione numerica di particelle (PNC) e di idrocarburi policiclici aromatici (IPA), nella città portuale di Brindisi. Le attività sono state condotte nell’ambito del progetto CESAPO da giugno a ottobre 2012. I contributi al PM2.5 ed al PNC sono stati ricavati con una metodologia basata sull’accoppiamento di misure ad alta risoluzione temporale, direzione del vento e database dei transiti delle navi. Sono state calcolate le medie a breve periodo (1 min) dei dati di concentrazione di PM2.5 e PNC per mettere in evidenza i picchi di breve durata nelle serie temporali associate alle attività portuali, alle navi ed al traffico veicolare connesso con le operazioni di carico e scarico. Le emissioni delle navi durante le fasi di manovra e stazionamento mostrano un chiaro pattern giornaliero, con due picchi distinti, specialmente per PNC, alle 7:00 e alle 18:00, da specifici settori di direzione del vento. Secondo l’approccio sviluppato da Contini et al. (2011, Journal of Environmental Management 92, 2119-2129), il contributo dovuto al traffico navale è pari al 7.4% (± 0.5%) per il PM2.5 ed al 26% (± 1%) per il PNC. Considerando anche il contributo delle attività portuali connesse, tali valori passano al 9.3% (± 0.5%) e al 39% (± 1%), rispettivamente. La concentrazione di IPA risulta maggiore nei campioni del settore portuale/industriale (5.34 ng/m3) rispetto all’intera area di Brindisi (3.89 ng/m3), soprattutto per il fenantrene e il fluorene. Il contributo locale dell’area portuale/industriale alla concentrazione di IPA nella fase gassosa è pari al 24%, mentre nella fase particolato è del 35%. Il contributo generale della stessa area agli IPA è del 54% e del 62%, rispettivamente in fase gassosa e particolato

Management of spontaneous bleeding in covid-19 inpatients: Is embolization always needed?

Background: critically ill patients with SARS-CoV-2 infection present a hypercoagulable condition. Anticoagulant therapy is currently recommended to reduce thrombotic risk, leading to potentially severe complications like spontaneous bleeding (SB). Percutaneous transcatheter arterial embolization (PTAE) can be life-saving in critical patients, in addition to medical therapy. We report a major COVID-19 Italian Research Hospital experience during the pandemic, with particular focus on indications and technique of embolization. Methods: We retrospectively included all subjects with SB and with a microbiologically confirmed SARS-CoV-2 infection, over one year of pandemic, selecting two different groups: (a) patients treated with PTAE and medical therapy; (b) patients treated only with medical therapy. Computed tomography (CT) scan findings, clinical conditions, and biological findings were collected. Results: 21/1075 patients presented soft tissue SB with an incidence of 1.95%. 10/21 patients were treated with PTAE and medical therapy with a 30-days survival of 70%. Arterial blush, contrast late enhancement, and dimensions at CT scan were found discriminating for the embolization (p < 0.05). Conclusions: PTAE is an important tool in severely ill, bleeding COVID-19 patients. The decision for PTAE of COVID-19 patients must be carefully weighted with particular attention paid to the clinical and biological condition, hematoma location and volume

Atmospheric impact of ship traffic in four Adriatic-Ionian port-cities: Comparison and harmonization of different approaches

Shipping is a growing transport sector representing a relevant share of atmospheric pollutant emissions at global scale. In the Mediterranean Sea, shipping affects air quality of coastal urban areas with potential hazardous effects on both human health and climate. The high number of different approaches for investigating this aspect limits the comparability of results. Furthermore, limited information regarding the inter-annual trends of shipping impacts is available. In this work, an approach integrating emission inventory, numerical modelling (WRF-CAMx modelling system), and experimental measurements at high and low temporal resolution is used to investigate air quality shipping impact in the Adriatic/Ionian area focusing on four port-cities: Brindisi and Venice (Italy), Patras (Greece), and Rijeka (Croatia). Results showed shipping emissions of particulate matter (PM) and NOx comparable to road traffic emissions at all port-cities, with larger contributions to local SO2 emissions. Contributions to PM2.5 ranged between 0.5% (Rijeka) and 7.4% (Brindisi), those to PM10 were between 0.3% (Rijeka) and 5.8% (Brindisi). Contributions to particle number concentration (PNC) showed an impact 2-4 times larger with respect to that on mass concentrations. Shipping impact on gaseous pollutants are larger than those to PM. The contribution to total polycyclic aromatic hydrocarbon (PAHs) concentrations was 82% in Venice and 56% in Brindisi, with a different partition gas-particle because of different meteorological conditions. The inter-annual trends analysis showed the primary contribution to PM concentrations decreasing, due to the implementation of the European legislation on the use of low-sulphur content fuels. This effect was not present on other pollutants like PAHs. (C) 2016 Elsevier Ltd. All rights reserved

Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia

Prophylactic low molecular weight heparin (pLMWH) is currently recommended in COVID-19 to reduce the risk of coagulopathy. The aim of this study was to evaluate whether the antinflammatory effects of pLMWH could translate in lower rate of clinical progression in patients with COVID-19 pneumonia. Patients admitted to a COVID-hospital in Rome with SARS-CoV-2 infection and mild/moderate pneumonia were retrospectively evaluated. The primary endpoint was the time from hospital admission to orotracheal intubation/death (OTI/death). A total of 449 patients were included: 39% female, median age 63 (IQR, 50–77) years. The estimated probability of OTI/death for patients receiving pLMWH was: 9.5% (95% CI 3.2–26.4) by day 20 in those not receiving pLMWH vs. 10.4% (6.7–15.9) in those exposed to pLMWH; p-value = 0.144. This risk associated with the use of pLMWH appeared to vary by PaO2/FiO2 ratio: aHR 1.40 (95% CI 0.51–3.79) for patients with an admission PaO2/FiO2 ≤ 300 mmHg and 0.27 (0.03–2.18) for those with PaO2/FiO2 > 300 mmHg; p-value at interaction test 0.16. pLMWH does not seem to reduce the risk of OTI/death mild/moderate COVID-19 pneumonia, especially when respiratory function had already significantly deteriorated. Data from clinical trials comparing the effect of prophylactic vs. therapeutic dosage of LMWH at various stages of COVID-19 disease are needed

Risk and predictive factors of prolonged viral RNA shedding in upper respiratory specimens in a large cohort of COVID-19 patients admitted to an Italian reference hospital

Background: Limited data are available about the predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS). Methods: A retrospective study including COVID-19 patients admitted to an Italian hospital between March 1 and July 1, 2020. Predictors of viral clearance (VC) and prolonged VS from the upper respiratory tract were assessed by Poisson regression and logistic regression analyses. The causal relation between VS and clinical outcomes was evaluated through an inverse probability weighted Cox model. Results: The study included 536 subjects. The median duration of VS from symptoms onset was 18 days. The estimated 30-day probability of VC was 70.2%. Patients with comorbidities, lymphopenia at hospital admission, or moderate/severe respiratory disease had a lower chance of VC. The development of moderate/severe respiratory failure, delayed hospital admission after symptoms onset, baseline comorbidities, or D-dimer >1000 ng/mL at admission independently predicted prolonged VS. The achievement of VC doubled the chance of clinical recovery and reduced the probability of death/mechanical ventilation. Conclusions: Respiratory disease severity, comorbidities, delayed hospital admission and inflammatory markers negatively predicted VC, which resulted to be associated with better clinical outcomes. These findings highlight the importance of prompt hospitalization of symptomatic patients, especially where signs of severity or comorbidities are present