ABSTRACT
Pollution is one of the main problems faced by cities nowadays, due to the increase in emissions from anthropogenic sources resulting from economic, industrial and demographic development. High values of pollutants, such as atmospheric particulate matter, lead to adverse effects on the environment and human health, causing the spread of respiratory, cardiovascular and neurological problems. For instance, recent work shows a connection between the spread of the Covid-19 pandemic and environmental pollution. In this context, urban monitoring of pollutants can allow to evaluate and perform actions aimed at reducing pollution in order to safeguard citizens' health. This study proposes a method to design an urban air quality monitoring system. It uses the AHP multi-criteria decision-making technique to define the initial positioning of the sensors, and the cellular automata mathematical model for the following optimization, from which the final configuration of the network is derived. In the present case study, the monitoring concerns atmospheric particulate matter (PM10 and PM2.5) and is carried out with six sensors that constitute a LoRaWAN network, as often used for monitoring activities in smart cities.
ABSTRACT
Background: Coronavirus Disease (COVID-19) could be considered as a human model of marked inflammation combined with severe hypoxia. In this setting, both erythropoiesis and iron metabolism appear to be profoundly affected by inflammatory and hypoxic stimuli, which act in the opposite direction. In patients with SARS-CoV-2 infection, Hb levels tend to be relatively high even in the context of severe disease and marked inflammation. A better understanding of erythropoiesis and iron metabolism in COVID-19 could contribute to elucidate the relationship between hypoxia and inflammation on erythropoietic control. Aims: To investigate the prevalence of anemia, the alterations of iron homeostasis,and the relationship between inflammation,hypoxia and erythropoiesis in a cohort of COVID-19 patients admitted both to medical wards and intensive care unit (ICU). Methods: We retrospectively analyzed data of 303 patients with COVID- 19 (178 subjects admitted to medical wards and 125 subjects admitted to the ICU). Biochemical parameters were collected on admission (T0), after 7 days of hospitalization (T1) and at discharge/death (T2). Results: The median age of the patients was 62 years (53-71) and 72% were males. ICU patients had lower mean Hb levels compared to non- ICU patients (11.3±1.8 vs 12.8±1.8 g/dL at T0, 10.2±1.6 vs 12.2±1.9 g/ dL at T1, 10±1.4 vs 12±1.7 g/dL at T2;p<0.001). Mean Hb concentration did not fall under 12 g/dl in the non-ICU group and under 10 g/ dl in the ICU group during hospitalization. Hb decreased by approximately 1 g/dl in both cohorts during the first 7 days of hospitalization, then remained stable until discharge. ICU patients also showed increased inflammatory markers and ferritin levels (1401 vs 839 mcg/l at T0, p<0.001;913 vs 832 mcg/L at T1, p ns;764 vs 651 mcg/L at T2, p ns). There were no significant differences in other iron parameters between groups. Hypoxia was a prominent feature of ICU patients (P/F ratio 91 vs 224, p<0.001). Patients who were anemic on admission maintained relatively constant Hb concentrations from T0 to T2 (10.8 g/dL at T0, 10.2 g/dL at T1 and 10.4 g/dL at T2), thus remaining in a range of mild to moderate anemia. Conversely, the non-anemic group displayed a greater reduction of Hb levels (13.7 g/dl at T0, 12.7 g/dl at T1, 12 g/dl at T2). Anemic subjects were more hypoxic than non-anemic patients (P/F 151 vs 292 at T0, p<0.001) and showed significantly higher levels of CRP (10.8 vs 6.6 mg/dL), IL-6 (60.3 vs 47.7 ng/L) and leukocyte count (7290 vs 6130 x109/L). Ferritin was higher in anemic patients at T0 and T1 (1220 vs 926 mcg/L and 852 vs 896 mcg/L, p ns), decreasing more at T2 (655 vs 763 mcg/L, p ns). Median hepcidin levels, which were available for a limited subset of non- ICU patients, were elevated during the whole period: 233 ng/mL at T0, 95 ng/mL at T1 and 60 ng/mL at T2. Summary/Conclusion: In patients with SARS-CoV-2 infection, two main factors influence erythropoiesis and iron homeostasis: systemic inflammation and profound hypoxia. Markedly high ferritin and hepcidin levels reflect a strong inflammatory response. However, COVID-19 patients tend to have disproportionately high Hb levels in the contest of the inflammatory milieu. The absolute reduction in Hb levels is more prominent in patients who displayed normal Hb on admission. Conversely, anemic and profoundly hypoxic subjects show constant mean Hb levels over time. Thus, we can hypothesize that the erythropoietic drive provided by hypoxia could counterbalance the effect of inflammation on hepcidin regulation, preventing Hb levels from falling dramatically during hospitalization.
ABSTRACT
Background: SARS-COV2 is a threatful viral disease which can evolve into respiratory failure but identification of risk factors for progression towards severe forms is still ongoing During infection impairment of liver function tests has been frequently reported and evidence of the negative impact of metabolic alterations on the clinical course are emerging, mainly evaluated in Asiatic populations Aim: to define the prognostic role of metabolic disease and liver damage on SARS-COV2 severity in a cohort of Italian patients Methods: All patients with confirmed COVID-19 infection admitted to low-intensity care COVID Units between March and April 2020 were enrolled Severe SARS-COV2 infection was defined according to International consensus requiring intensive respiratory support (CPAP/orotracheal intubation) All data were collected at admission Results: 382 patients were enrolled, mean age was 65±17 ys and 60% were male Mean BMI was 27±5 kg/m2 (61% overweight and 25% obese), prevalence of T2DM 17%, hypertension 44%, dyslipidemia 29% At admission 39% and 40% of patients had increased ALT and GGT levels, respectively Median hospitalization stay was 14 days (IQR 8-24), with 30% of patients experiencing severe SARS-COV2 infection and mortality in 14% of overall cases Subjects with severe infection presented higher prevalence of male sex (68% vs 56%, p=0 03), T2DM (25% vs 14%, p=0 01), dyslipidemia (36% vs 26%, p=0 05) and increased ALT (53% vs 32%, p<0 001) and GGT (53% vs 34%, p=0 01) levels at admission In multivariate analysis (adjusted for age, sex, T2DM, dyslipidemia, increased ALT and GGT at admission and SARS-COV2 therapy), T2DM (OR 3 1, 95%CI 1 6-6 0;p=0 001), dyslipidemia (OR 1 9, 95%CI 1 1-3 3;p=0 03), and increased ALT (OR 4 7, 95%CI 2 5- 9 0;p<0 001) and GGT (OR 2 0, 95%CI 1 2-3-3;p=0 009), resulted associated with high risk of more severe SARSCOV2 disease Interestingly, in patients with both T2DM and dyslipidemia, this risk was further increased (OR 5 2, 95%CI 2 1-12 6;p<0 001) Conclusion: We confirm that liver involvement is common during SARS-COV2 infection and it is a negative prognostic factor although it is not clear whether it precedes or follows, the severity of clinical course In addition, the risk of severe form of respiratory distress is increased by metabolic alterations, and the more numerous the alterations, the higher the risk.
ABSTRACT
The COVID-19 pandemic is posing an unprecedented challenge to healthcare systems worldwide. Older adults, which frequently present multiple chronic comorbidities, are more susceptible to COVID-19 and experience more likely negative outcomes, in terms of disease severity and mortality. However, chronological age per se may not entirely explain the dramatic scenario described among the frailest and oldest persons. Comorbidities and functional status may indeed play a relevant role. Patients at high risk of adverse clinical outcomes in COVID-19 infection are the same at risk of malnutrition, namely older adults and multimorbid individuals. In fact, COVID-19 can negatively impact on nutritional status, both in patients admitted to the hospital with the most severe manifestations of the infection, as well as in those who experience milder/asymptomatic forms of the disease. Despite being quite difficult in these emergency circumstances, nutritional status needs to be assessed in all COVID-19 patients upon admission and during hospital stay. Early nutritional support should be guaranteed in order to improve several malnutrition-related adverse outcomes. The evaluation of the nutritional status is today even more crucial than in normal times given the delicate status of older patients with COVID-19.