Occurrence of per- and polyfluorinated alkyl substances in wastewater treatment plants in Northern Italy.

Wastewater treatment plants are known to be relevant input sources of per- and polyfluoroalkyl substances (PFAS) in the aquatic environment. This study aimed to investigate the occurrence, fate, and seasonal variability of twenty-five PFAS in four municipal wastewater treatment plants (WWTP A, B, C, and D) surrounding the city of Milan (Northern, Italy). Composite 24-h wastewater samples were collected in July and October 2021 and May and February 2022 from influents and effluents of the four WWTPs. PFAS were detected at concentrations ranging between 24.1 and 66.9 µg L-1 for influent and 13.4 and 107 µg L-1 for effluent wastewater samples. Perfluoropentanoic acid was the most abundant (1.91-30.0 µg L-1) in influent samples, whereas perfluorobutane sulfonic acid predominated (0.80-66.1 µg L-1) in effluent samples. In sludge, PFOA was detected in plant A at concentrations in the range of 96.6-165 ng kg-1 dw in primary sludge samples and 98.6-440 ng kg-1 dw in secondary treatment sludge samples. The removal efficiency of total PFAS varied between 6 % and 96 %. However, an increase of PFAS concentrations was observed from influents to effluents for plant D (during July and October), plant A (during October and May), and plant C (during May) indicating that biotransformation of PFAS precursors can occur during biological treatments. This was supported by the observed increase in concentrations of PFOA from primary to secondary treatment sludge samples in plant A. Moreover, the plant operating at shorter hydraulic retention times (plant D) showed lower removal efficiency (<45 %). Seasonal variation of PFAS in influent and effluent appears rather low and more likely due to pulse release instead of seasonal factors.

Particle and gas phase sampling of PCDD/Fs and dl-PCBs by activated carbon fiber and GC/MS analysis.

Polychlorodibenzo-p-dioxins (PCDDs), polychlorodibenzofurans (PCDFs), and polychlorobiphenyls (PCBs) are semi-volatile compounds and can be partitioned in the atmosphere between the gas and particulate phase, due to their physicochemical properties. For this reason, the reference standard methods for air sampling include a quartz fiber filter (QFF) for the particulate and a polyurethane foam (PUF) cartridge for the vapor phase, and it is the classical and most popular sampling method in the air. Despite the presence of the two adsorbing media, this method cannot be used for the study of the gas-particulate distribution, but only for a total quantification. This study presents the results and the performance aim to validate an activated carbon fiber (ACF) filter for the sampling of PCDD/Fs and dioxin-like PCBs (dl-PCBs) using laboratory and field tests. The specificity, precision, and accuracy of the ACF in relation to the QFF + PUF were evaluated through the isotopic dilution technique, the recovery rates, and the standard deviations. Then the ACF performance was assessed on real samples, in a naturally contaminated area, through parallel sampling with the reference method (QFF + PUF). The QA/QC was defined according to the standard methods ISO 16000-13 and -14 and EPA TO4A and 9A. Data confirmed that ACF meets the requirements for the quantification of native POPs compounds in atmospheric and indoor samples. In addition, ACF provided accuracy and precision comparable to those offered by standard reference methods using QFF + PUF, but with significant savings in terms of time and costs.

Extractable denuders for selective sampling of vapour phase organics in the atmosphere.

Extractable denuders were designed to collect trace atmospheric semivolatile organic compounds with high volume (38.30 and 200 L/ min) samplers. Denuders were made of multichannel ceramic support coated with sodium silicate and functionalised with phenyl moieties. Polycyclic aromatic hydrocarbons, polychlorinated biphenyls, polychlorinated dibenzodioxins and polychlorinated dibenzofurans and chlorobenzenes in ambient air of a sub-urban area of Monterotondo, Italy, were sampled. Samplings were of 24 h, 48 h and 1 week period. Precision was determined using field triplicates and compared to the conventional high volume sampler methods. The fraction of analytes in the particle phase measured with the filter/ PUF system ranged from 0.2 % for naphthalene to 98.5 % for benzo(ghi)perylene; this fraction measured with the denuder ranged from 0.5 % for naphthalene to 99.0 % for benzo(ghi)perylene. A paired t-test indicated that these values were significantly (t = 3.58, P < 0.01) higher for the denuder. Results showed good repeatability (0.4-4.6 %), sampling efficiency (>99 %) and good capacity as variations in experimental efficiency were not observed also for longer (1 week) period sampling. As significant changes in efficiency were observed (0.7-5.6 %), the developed denuder cannot be reused more than once. However, it is possible to regenerate the denuder with a new silanization step. A good linear correlation was found plotting the vapour/particle distribution ratio versus the vapour pressure (R2 ranged between 0.59 and 0.84) and versus the octanol/air partition coefficient (R2 ranged between 0.85 and 0.88) of each selected SVOCs, in good agreement with the theoretical models for partitioning of SVOCs.

Evaluation of Extraction Procedure of PCDD/Fs, PCBs and Chlorobenzenes from Activated Carbon Fibers (ACFs).

Active carbon-based sorbents are well known and are used in analytical chemistry. Activated carbon fibers (ACFs) are mainly used as abatement systems in industrial emission pollution control. The objective of this study was to extend the use of ACFs in analytical chemistry for the analysis of polychlorodibenzo-p-dioxins (PCDDs), polychlorodibenzofurans (PCDFs), dioxin-like polychlorobiphenyls (PCBs), and chlorobenzenes (CBs). For this purpose, the extraction efficiency was evaluated based on the QA/QC criteria defined by EPA/ISO reference methods on 13C-standards recovery rates. The procedures tested were ultrasonic assisted extraction (UAE), Soxhlet extraction (SE), accelerated solvent extraction (ASE), and microwave-assisted extraction (MAE). Each experiment was performed in triplicate to ensure the repeatability of the results, and a second extraction assessed the complete extraction. The comparison of the results of each set of experiments with the minimum requirements of the reference methods for each class of compounds led to SE being chosen as the best technique. SE with toluene resulted in a reduction of time and costs and with respect to the other investigated techniques. The present work demonstrated that ACFs can be used in environmental fields means of both prevention and control (exploiting the adsorbent characteristics) and for analytical purposes (exploiting the desorption) for the described chlorinated classes of pollutants.

Evaluation of the concentration of the toxic 2,3,6,7-tetrachlorobiphenylene in air after an electrical material fire.

It is known that when fires or explosions involve electrical systems, along with PCDDs and PCDFs, polychlorinated biphenylenes (PCBPs) are also produced. These chlorinated tricyclic aromatic pollutants were noticed in fire rubbles and after the World Trade Center destruction. However, the analytical difficulties in developing an efficient method have limited the knowledge of their environmental distribution. In light of the equipotency of 2,3,6,7-TeCBP and 2,3,7,8-TeCDD, PCBPs call for more accurate investigations. In this paper, for the first time, the level and persistence of 2,3,6,7-TeCBP have been investigated in air samples (both indoor and outdoor) after a fire broke out in an industrial building. GC-MS/MS analysis revealed that 2,3,6,7-TeCBP concentrations after the fire (3046 fg/m3 at the "epicentre") were remarkably higher than that of the 2,3,7,8-TeCDD. Moreover, the monitoring for over two years has demonstrated the persistent nature of this compound. 2,3,6,7-TeCBP was also analyzed in two different ambient air scenario: industrial and periurban areas and in both cases its concentrations were no matter of concern, confirming the correlation of 2,3,6,7-TeCBP with fire episodes. Collectively, 2,3,6,7-TeCBP, because of its toxicity, concentration and persistence, is a crucial compound in the evaluation of the health effects correlated with fires of electrical systems.

Environmental impact of co-combustion of polyethylene wastes in a rice husks fueled plant: Evaluation of organic micropollutants and PM emissions.

Co-combustion of biomass and plastic waste has emerged as one of the most promising approach at the plastic waste management challenge. This strategy is particularly attractive since it can simultaneously solve the increasing energy demand and reduce the plastic wastes volume. However, since the combustion of both plastic wastes and natural materials is a potential source of organic micropollutants, such as polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), polychlorinated biphenyls (PCBs) and of polycyclic aromatic hydrocarbons (PAHs), beside particulate matter, the environmental sustainability of the waste to energy (WtE) co-combustion strategy has to be assessed. To this end, the emissions of dioxin like (dl)-PCBs, PCDD/Fs and PAHs from a 4-MW thermal power plant fueled with rice husk, partially replaced by end-of-life polyethylene (PE) industrial waste (up to 15% of the thermal power of the plant), were investigated. GC-MS/MS analyses have demonstrated that the co-combustion of PE waste and rice husk presents a profile of environmental sustainability. The concentrations of dl-PCBs, PCDD/Fs and PAHs were extremely low and they have remained almost unaffected by introducing PE in feed. In particular, emissions of PCCD/Fs and dl-PCBs in flue gas were in the range 0.6-1.0 and 0.2-0.6 pg TEQ/Nm3, respectively, while PAHs concentrations ranged from 410 to 825 ng/Nm3. Furthermore, the emission factors of these organic pollutants were found to be lower with PE increasing rate while particulate matter emissions were not affected by co-combustions. Collectively, the investigation has demonstrated that the noils of the industrial PE, due to the low content in halides and metals, can be used as auxiliary fuel and energetically recycled through co-combustion with rice husk. This case of study represents an effective application of the WtE strategy and a concrete approach to mitigate the threat of plastic pollution.

Validation studies on activated carbon fiber passive sampler for PCDD/Fs and PCBs in water.

The toxicity of polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) is well known, and for this reason studying and monitoring these chemicals is fundamental. Activated carbon fibers (ACFs) are made of an adsorbent material widely used in the industrial field for the removal of micropollutants. The first step in this work was to perform a physico-chemical characterization of the adsorbent, focused on the analytical use of it. In particular, its specific surface area was defined around 2500 m2/g consisting in a homogeneous microporosity distribution and the characterization of ACF surface functional groups pointed out a balance between basic and acidic group. The validity of using the ACF as solid phase extraction and as passive sampler for PCDD/Fs and PCBs in water, has been evaluated by the percentage recovery (R %) of 13C12-labeled standards of PCDD/Fs and PCBs added in a known volume of water. The results were compared to the R% of Liquid-Liquid Extraction which showed a better reproducibility of the results and the proposed method satisfy completely the requirements of US EPA reference methods.

Analysis of polychlorodibenzo-p-dioxins and polychlorodibenzofurans in stationary source emissions in GC-MS/MS using hydrogen as the carrier gas.

The European and American methods for the determination of polychlorodibenzo-p-dioxins and polychlorodibenzofurans in stationary source emissions require a high-resolution mass spectrometer detector. At the same time, all of the 17 toxic 2,3,7,8-chlorine-substituted isomers have to be separated by an appropriate chromatographic method. The resulting analysis has long runtimes and sometimes a double-column run is needed, which results in a huge waste of time, money and manual labor. To obtain a fast and cost-effective but still reliable analytical system, a single-column gas chromatography with hydrogen as carrier gas and tandem mass spectrometry detection is proposed. The use of hydrogen as the carrier gas is a good choice to shorten runtimes and improve the chromatographic resolution, while tandem mass spectrometry is a well-known alternative for this analysis. All the chromatographic and mass spectrometric parameters fill the requirements of the reference methods with a 35% reduction of runtimes. The accuracy is tested with three fly ash samples of a proficiency interlaboratory test. A good correlation between the results is obtained (R2  = 0.992, slope = 0.9675), and no coelutions are noted. The system robustness is tested during 5 years of constant use and the maximal relative standard deviation of the relative response factor is 18.8%.

Emission of submicron aerosol particles in cement kilns: Total concentration and size distribution.

Cement plants are responsible for particle and gaseous emissions into the atmosphere. With respect to particle emission, the greater part of is in the range from 0.05 to 5.0 µm in diameter. In the last years attention was paid to submicron particles, but there is a lack of available data on the emission from stationary sources. In this paper, concentration and size distribution of particles emitted from four cement kilns, in relationship to operational conditions (especially the use of alternative fuel to coal) of the clinker process are reported. Experimental campaigns were carried out by measuring particles concentration and size distribution at the stack of four cement plants through condensation particle counter (CPC) and scanning mobility particle sizer spectrometer (SMPS). Average total particle number concentrations were between 2000 and 4000 particles/cm³, about 8-10 times lower that those found in the corresponding surrounding areas. As for size distribution, for all the investigated plants it is stable with a unimodal distribution (120-150 nm), independent from the fuel used.

Assessment of nitrous oxide emission from cement plants: real data measured with both Fourier transform infrared and nondispersive infrared techniques.

Nitrous oxide (N2O) is the third most important greenhouse gas after carbon dioxide and methane, and contributes about 6% to the greenhouse effect. Nitrous oxide is a minor component of the atmosphere, and it is a thousand times less than carbon dioxide (CO2). Nevertheless, it is much more potent than CO2 and methane, owing to its long stay in the atmosphere of approximately 120 yr and the high global warmingpotential (GWP) of298 times that of CO2. Although greenhouse gases are natural in the atmosphere, human activities have changed the atmospheric concentrations. Most of the values of emission of nitrous oxide are still obtained by means ofemission factors and not actually measured; the lack ofreal data may result in an underestimation ofcurrent emissions. The emission factors used for the calculation of N2O can be obtained from the "Guidelines for the implementation of the national inventory of emissions" of the Intergovernmental Panel on Climate Change, which refer to all nations for the realization of their inventory. This study will present real data, measured in several Italian cement plants with different characteristics. The work also shows a comparison between N2O concentration measured with in situ-Fourier transform IR (FTIR) and the reference method EN ISO 21258 based on nondispersive IR (NDIR), in order to investigate the interfering compounds in the measurement with NDIR.

Determination of 5-ethylidene-2-norbornene in industrial emission.

A method to measure the emissive concentration of 5-ethylidene-2-norbornene (ENB), a reactive compound used in industrial synthesis of terpolymers, has been developed. The starting points for the development of the presented method are European and Italian reference methods for the quantification of nonreactive volatile organic compounds in industrial emission. In this study, sampling conditions and desorption solvent have been optimized in laboratory and the method was applied in an industrial plant. The laboratory tests showed a good recovery (88-95%). The concentrations of ENB in industrial emission obtained with the developed method were compared with an online gas chromatography-flame ionization results (R (2) > 0.97). In addition, several manual measurements were performed in parallel, and the resulting %RSD repeatability was <9%. The developed method provides a discontinuous technique to measure reactive volatile organic compounds using easy-to-use instruments and assures a very good accuracy and precision even with high-humidity gas flows. The method could be extended to other reactive compounds of the same class.

Development of a new automated clean-up system for the simultaneous analysis of polychlorinated dibenzo-p-dioxins (PCDDs), dibenzofurans (PCDFs) and 'dioxin-like' polychlorinated biphenyls (dl-PCB) in flue gas emissions by GPC-SPE.

A comprehensive clean-up method for quantitative analysis of polychlorinated biphenyls (PCBs) and polychlorinated dibenzo-p-dioxins and dibenzo-furans (PCDD/Fs) in one single extract of environmental samples was developed. Since the chemical nature and toxicity of planar PCBs are similar to those of PCDD/Fs, dioxin-like PCBs and PCDD/Fs are often surveyed together in their exposure assessments. The development of a method for the simultaneous analysis of PCBs and PCDD/Fs in environmental samples is invaluable. The automated clean-up system evaluated in this work consists of three additional steps after traditional extraction: the chromatography on gel permeation (GPC), the concentration of the solvent through the use of an in-line evaporation module and the further purification and separation of PCDDs/Fs and dl-PCBs on an alumina cartridge in the 'SPE module'. In this work, three fly ash samples from an interlaboratory study with different PCDD/F and PCB levels were Soxhlet-extracted and then cleaned up using an automated system. PCDD/Fs and PCBs were determined using isotope dilution and high resolution gas chromatography/high resolution mass spectrometry. The determined values of 17 PCDD/Fs were consistent with the certified values and the relative standard deviations (RSDs) of the determined values were less than 20%. The recoveries of (13)C labeled PCDD/Fs and planar PCBs, and their RSDs were within the ranges specified in EPA1613 and 1668a methods, respectively. An accurate and reliable method was successfully developed and can be used in the simultaneous analysis of PCDD/Fs and planar PCBs in environmental samples.

Marcadores clínicos y humorales relacionados con la mortalidad en pacientes con insuficiencia cardíaca clase funcional III/IV / Clinical and humoral markers associated with mortality in patients with heart failure functional class III/IV / Marcadores clínicos e humorais associados com a mortalidade em pacientes com insuficiência cardíaca classe funcional III/IV

Objetivos. Observar, en pacientes con miocardiopatía dilatada (MD) e insuficiencia cardíaca (IC) clase funcional III/IV de la New York Heart Association, la existencia de variables clínicas y humorales que se comporten como predictores de riesgo para mortalidad. Material y métodos. Se incorporaron en forma consecutiva 84 pacientes con MD e IC de más de un año de antigüedad en su diagnóstico (media 3,3 años/DS 2,1), internados en la unidad coronaria por descompensación cardíaca. Se dividieron los pacientes en dos grupos: grupo no muertos (GV) de n=60 y el grupo de aquellos que fallecieron (GM) de n=24. A los fines del estudio se compararon: número de reinternaciones, comorbilidades, cumplimiento del tratamiento higiénico-dietético, adhesión al tratamiento farmacológico, tratamiento farmacológico al ingreso (drogas), y las variables bioquímicas: natremia, conteo de leucocitos en sangre, glucemia, creatininemia y bilirrubinemia. Resultados. Todos los pacientes tenían índice cardiotorácico >0,5 y deterioro moderado a severo de la función ventricular por ecocardiograma en ambos grupos. En el GM el fallecimiento se produjo durante la internación. En la distribución por sexo, predominó el masculino (GV: 83,3% y GM: 70,8%; p=NS), edad GV: 61,3±11,0 años y GM: 63,9±11,3 (p=NS). Conclusión. De todas las variables analizadas, se asociaron a peor pronóstico: el mayor número de reinternaciones, la leucocitosis (glóbulos blancos en sangre > 11000 por mm3) y la creatininemia con valores > 2 mg/dL.

Aim. To study the existence of clinical and humoral variables that behave as predictors of mortality risk in patients with dilated cardiomyopathy (DCM) and heart failure (HF) functional class III/IV New York Heart Association. Material and methods. We consecutively included 84 patients with DCM and HF over a year old of diagnosis (mean 3.3 years/SD 2.1), hospitalized at coronary care unit due to cardiac decompensation. Patients were divided into two groups: not dead group (GV) n=60, and group of those who died (GM) n=24. At the end of the study we compared: rehospitalizations, comorbidities, hygienic-dietary treatment accomplishment, adherence to pharmacological treatment, pharmacological treatment at income (drugs), and biochemical variables: natremia, white blood cell count, glucose, creatinine in blood, bilirubinemia. Results. Every patient had cardiothoracic index >0.5 and moderate to severe impairment of ventricular function by echocardiogram among both groups. Within sex distribution there was a masculine predominance (GV: 83.3% and GM: 70.8%; p=NS), age GV: 61.3±11.0 years old and GM: 63.9±11.3 (p=NS). Conclusion. Of all analyzed variables, were associated with worst prognosis: the largest number of readmissions, treatment with furosemide, leukocytosis (white blood cells > 11000 per mm3) and creatinine values > 2 mg/dL.

Objetivos. Estudar a existência de variáveis clínicas e humorais que se comportam como preditores de risco de mortalidade em pacientes com cardiomiopatia dilatada (CMD) e insuficiência cardíaca (IC) em classe funcional III/IV da New York Heart Association. Material e métodos. Foram adicionados consecutivamente 84 pacientes com CMD e IC ao longo de um ano de idade no momento do diagnóstico (média de 3,3 anos/DP=2,1), internados na unidade coronariana por descompensação cardíaca. Os pacientes foram divididos em dois grupos: grupo não morto (GV) n=60, e o grupo dos que morreram (GM) n=24. No final do estudo foram comparados: reinternações, co-morbidades, cumprimento de tratamento higiênico- dietético, adesão ao tratamento medicamentoso, tratamento medicamentoso de admissão (drogas), e variáveis bioquímicas: sódio sérico, contagem de células brancas do sangue, glicemia, creatinina e bilirrubina. Resultados. Todos os pacientes tiveram um índice cardiotorácico >0,5 e comprometimento da função ventricular pela ecocardiografia de moderada a grave em ambos os grupos. Na distribuição por sexo, houve predomínio do sexo masculino (GV: 83,3% e GM: 70,8%, p=NS), idade GV: 61,3±11,0 anos e GM: 63,9±11,3 (p=NS). Conclusão. De todas as variáveis analisadas foram associados com pior prognóstico: maior número de reinternações, tratamento com furosemida, leucocitose (glóbulos brancos > 11000 por mm3 e valores de creatinina >2 mg/dL.

¿Se utiliza el tratamiento aconsejado en base a la evidencia en pacientes con insuficiencia cardíaca por disfunción sistólica? / Is the advised evidence-based treatment in patients with heart failure due to systolic dysfunction used? / ¿à‰ utilizado o tratamento recomendado baseada em evidências em pacientes com insuficiência cardíaca devido à disfunção sistólica?

Objetivo. Valorar si los pacientes con insuficiencia cardíaca (IC) por disfunción sistólica, clase funcional (CF) III/IV de la New York Heart Association (NYHA) internados en la Unidad Coronaria recibían previamente a su ingreso tratamiento farmacológico basado en la evidencia publicada. Material y método. Estudio prospectivo de pacientes internados de manera consecutiva en la unidad coronaria en el período Junio2007-Junio 2009. Se incluyeron pacientes con IC portadores de miocardiopatía dilatada CF III/IV, con deterioro de la función ventricular (FV) por ecocardiograma, quedando conformados 2 grupos: los de diagnóstico de IC al ingreso, grupo ingreso (GI), en los cuales se comparó su medicación al egreso del hospital versus el tratamiento al egreso del GT, y aquellos con diagnóstico de antigà»edad mayor a 1 año (3,3 años/DS 2,1), denominado grupo tratamiento (GT), en los cuales se comparó su medicación al ingreso y egreso del hospital. Para el análisis estadístico se empleó test de proporciones del programa Statistix corregido por la prueba de Fisher’s. Resultados. La edad promedio fue 55,2±11,2 años GI y 60,3±11,3 años GT (p=NS), hubo predominancia del sexo masculino (65% GI y 79,7% GT). Todos presentaron cardiomegalia en la radiografía de tórax, deterioro moderado a severo de la FV en el 90% del GI y en el 83,3% del GT (p=NS), y la mortalidad fue de 4 pacientes en el GI (18,1%) y de 24 pacientes en el GT (28,5%) (p=NS). En el GT, la indicación del tratamiento basado en la evidencia de los pacientes al ingreso al hospital fue relativamente baja (60,7% para furosemida; 32,1% para espironolactona; 58,3% para inhibidores de la enzima convertidora de angiotensina (IECA); 25% para betabloqueantes y 27,3% para digital), siendo mejorados estos porcentajes con el tratamiento al egreso. En el grupo GI, el tratamiento al egreso fue similar al GT en la optimización de los recursos terapéuticos. Conclusión. Las comparaciones entre el tratamiento del GI y del GT al egreso del hospital sólo arrojaron diferencia estadísticamente significativa en la indicación de betabloqueantes. El tratamiento farmacológico de los pacientes ambulatorios con IC es subóptimo según la evidencia, y la tolerabilidad a un mayor empleo de fármacos con fuerte impacto en la morbimortalidad no es un condicionante que limite su empleo.

Aim. To assess pharmacological evidence-based-treatment before admission in patients with heart failure (HF) due to systolic dysfunction, New York Heart Association functional class (FC) III/IV who are hospitalized at Coronary Unit. Material and methods. Prospective study of patients hospitalized consecutively at Coronary Unit within June 2007 - June 2009. Patients with HF and dilated cardiomyopathy FC III/IV and echocardiographic ventricular function impairment where included. Two groups where formed: patients with HF diagnosis within admission (admission group -AG-), in which we compared medication at discharge vs treatment at discharge of treatment group (TG); and patients with HF diagnosis for more than 1 year (3.3 years/SD 2.1), TG, in which we compared medication at admission vs medication at discharge. Proportions test, Statistix program, adjusted by Fisher’s test was used for statistical analysis. Results. Average age was 55.2±11.2 years in AG and 60.3±11.3 years in TG (p=NS). There was masculine dominance (65% AG and 79.7% TG). 90% of patients in AG and 83.3% of patients in TG (p=NS) presented cardiomegaly at chest X-ray and moderate to severe impairment of ventricular function; with a mortality of 4 patients in AG (18.1%) and 24 in TG (28.5%) (p=NS). In TG there was relatively low indication of evidence-based-treatment at admission (60.7% furosemide; 32.1% spirinolactone; 58.35% angiotensin converting enzyme inhibitors (ACEi); 25% beta blockers and 27.3% digitalis), showing better results in comparison with discharge treatment. Regarding therapeutic resorts optimization, AG treatment at discharge was similar than TG’s. Conclusion. Comparisons within AG and TG treatment at discharge only showed statistically significant differences about beta blocker indication. Based on evidence, HF outpatients pharmacological treatment is less optimal, and tolerability to a mayor use of drugs with high impact in morbidity and mortality does not constitute a limitation to its use.

Objetivo. Para avaliar farmacológica baseada em evidência o tratamento antes da admissão em pacientes com insuficiência cardíaca (IC), devido à  disfunção sistólica, classe funcional (CF) III/IV da New York Heart Association (NYHA) que estão internados na Unidade Coronariana. Material e métodos. Estudo prospectivo de pacientes internados consecutivamente na unidade coronariana no período Junho de 2007 - Junho de 2009, que incluiu pacientes com insuficiência cardíaca devido à  cardiomiopatia dilatada CF III, com deterioração da função ventricular (FV) pelo ecocardiograma, sendo formados dois grupos: aqueles com diagnóstico de insuficiência cardíaca na admissão, o grupo admissão (GA), em que comparou a sua medicação de alta hospitalar versus tratamento de descarga de GT, e aqueles diagnosticados com pelo menos um ano (3,3 anos / SD 2,1), chamou o grupo de tratamento (GT), onde medicação foi comparado à  admissão e alta hospitalar. A análise estatístico foi utilizado para teste de proporções do programa Statistix corrigido da prova Fisher’s. Resultados. A idade média foi de 55,2 ± 11,2 anos e 60,3 GA GT ± 11,3 anos (p = NS), eram predominantemente do sexo masculino (65% do GA e 79,7% GT). Todos tinham cardiomegalia na radiografia do tórax, de moderada a grave deterioração da FV em 90% do GA e 83,3% de GT (p = NS), ela mortalidade foi de 4 pacientes no GA (18,1%) e 24 pacientes do GT (28,5%) (p = NS). No GT, a indicação de tratamento baseada em evidências de pacientes em internação hospitalar foi relativamente baixa (60,7% para furosemida, espironolactona para 32,1%, 58,3% para os inibidores da enzima conversora de angiotensina (IECA), 25% de beta-bloqueadores e 27,3% para digital), sendo estas percentagens melhoraram com o tratamento no momento da alta. No grupo GA tratamento, a alta foi similar ao GT na otimização de recursos terapêuticos. Conclusão. As comparações entre o tratamento de GA e GT sobre a alta hospitalar jogou apenas diferenà§a estatisticamente significativa na indicação de beta-bloqueadores. O tratamento farmacológico de pacientes com insuficiência cardíaca é subótima de acordo com as provas, e maior tolerà¢ncia uso de drogas com um forte impacto na morbidade e mortalidade não é uma condição que limita a sua utilização.

Evaluation of a simultaneous sampling method of PAHs, PCDD/Fs and dl-PCBs in ambient air.

The Stockholm Convention on Persistent Organic Pollutants (POPs) was signed in May 2001 by 127 countries. Currently, 12 substances are regulated by the convention, and the work on finding new candidate chemicals to the convention has started. Among these 12 substances, dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and polychlorinated biphenyls (PCBs) are the objects of this study. There are no European standard methods for the simultaneous determination of these microorganic compounds, together with polycyclic aromatic hydrocarbons (PAHs) in ambient air--they must be referred to three different methods developed by the U.S. Environmental Protection Agency (EPA). The quali-quantitative analysis of these microorganic pollutants is an important challenge due to the low concentrations at which they may be present. In this study, the development of a simplified, alternative, fast and affordable sampling method for the determination of PAHs, PCDDs, PCDFs and PCBs in ambient air was performed. The sampling time was extended from 24 h to 7 d in order to enrich the sample, to fall within the instrumental limits of detection and to reduce the number of samples to be processed and, therefore, errors that may arise. First of all, experiments with labelled standards were conducted in the research area of Montelibretti (rural station, which is sited about 20 km northeast of Rome), with the purpose of optimizing sampling efficiency. Finally, the method was applied to the analysis of these compounds in the air of a suburban area with small industrial plants in order to evaluate the feasibility of the proposed sampling method system, by comparing concentrations of native compounds acquired during simultaneous daily and weekly sampling.

PCDD/Fs removal efficiency by electrostatic precipitator and wetfine scrubber in an iron ore sintering plant.

This study investigates the removal efficiency of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) by the APCDs of an iron ore sintering plant, an electrostatic precipitator (ESP) and a wetfine scrubbing system (WS). The removal efficiencies of the ESP on the total PCDD/Fs concentration and the total PCDD/Fs I-TEQ concentration are 44.3% and 41.4%, respectively, while those of the WS are 66.7% and 68.4%, respectively, but the vapor/solid phase distribution changes after APCDs abatement. At ESP inlet, the PCDD/Fs account for 31.2% in vapor phase and for 68.8% in particulate phase while, at ESP outlet, the PCDD/Fs account for 63.3% in vapor phase and for 36.7% in solid phase. The ESP removes effectively solid-phase PCDD/Fs for its effectiveness to capture the particulate while it is ineffective in removing vapor-phase PCDD/Fs. It, on the contrary, increase for the vaporization within the ESP, especially for these congeners with a lower chlorination degree, and for the PCDD/Fs "stripping" from particulate to gas-phase during the sampling. At WS inlet, the PCDD/Fs account for 63.3% in vapor phase and for 36.7% in solid phase while, at WS outlet, the PCDD/Fs account for 21.4% in vapor phase and for 78.6% in solid phase. Considering that WS outlet temperature is about 40 degrees C, the PCDD/Fs vapor-phase condense to particles: therefore, even if the particulate is removed by WS, the final result is that PCDD/Fs percentage decreases in vapor-phase and increases in solid-phase.