Adverse drug reactions in paediatric surgery: prospective study on frequency and risk related factors.

BACKGROUND: Paediatric patients are especially prone to experiencing adverse drug reactions (ADRs), and the surgical environment gathers many conditions for such reactions to occur. Additionally, little information exists in the literature on ADRs in the paediatric surgical population. We aimed to quantify the ADR frequency in this population, and to investigate the characteristics and risk factors associated with ADR development. METHODS: A prospective observational study was conducted in a cohort of 311 paediatric patients, aged 1-16 years, admitted for surgery at a tertiary referral hospital in Spain (2019-2021). Incidence rates were used to assess ADR frequency. Odds ratios (ORs) were calculated to evaluate the influence of potential risk factors on ADR development. RESULTS: Distinct ADRs (103) were detected in 80 patients (25.7%). The most frequent being hypotension (N = 32; 35%), nausea (N = 16; 15.5%), and emergence delirium (N = 16; 15.5%). Most ADRs occurred because of drug-drug interactions. The combination of sevoflurane and fentanyl was responsible for most of these events (N = 32; 31.1%). The variable most robustly associated to ADR development, was the number of off-label drugs prescribed per patient (OR = 2.99; 95% CI 1.73 to 5.16), followed by the number of drugs prescribed per patient (OR = 1.26, 95% CI 1.13 to 1.41), and older age (OR = 1.26, 95% CI 1.07 to 1.49). The severity of ADRs was assessed according to the criteria of Venulet and the Spanish Pharmacovigilance System. According to both methods, only four ADRs (3.9%) were considered serious. CONCLUSIONS: ADRs have a high incidence rate in the paediatric surgical population. The off-label use of drugs is a key risk factor for ADRs development.

Extracellular vesicles in cardiomyopathies: A narrative review.

Extracellular vesicles (EVs) are membrane-bound particles released by all cells under physiological and pathological conditions. EVs constitute a potential tool to unravel cell-specific pathophysiological mechanisms at the root of disease states and retain the potential to act as biomarkers for cardiac diseases. By being able to carry bioactive cargo (such as proteins and miRNAs), EVs harness great potential as accessible "liquid biopsies", given their ability to reflect the state of their cell of origin. Cardiomyopathies encompass a variety of myocardial disorders associated with mechanical, functional and/or electric dysfunction. These diseases exhibit different phenotypes, including inappropriate ventricular hypertrophy, dilatation, scarring, fibro-fatty replacement, dysfunction, and may stem from multiple aetiologies, most often genetic. Thus, the aims of this narrative review are to summarize the current knowledge on EVs and cardiomyopathies (e.g., hypertrophic, dilated and arrhythmogenic), to elucidate the potential role of EVs in the paracrine cell-to-cell communication among cardiac tissue compartments, in aiding the diagnosis of the diverse subtypes of cardiomyopathies in a minimally invasive manner, and finally to address whether certain molecular and phenotypical characteristics of EVs may correlate with cardiomyopathy disease phenotype and severity.

PM2.5 elemental composition in indoor residential environments and co-exposure effects on respiratory health in an industrial area.

This study aimed to identify and characterise indoor sources of particulate matter (PM) in domestic environments. 74 inhabited apartments located in the urban area of Gela (Sicily, Italy), close to a refinery, and in three villages of the hinterland were evaluated, in real-world conditions, for the elemental composition of PM2.5. The samples were collected simultaneously inside and outside each apartment for 48 h. In addition, two of the apartments were simultaneously studied for four weeks. The elemental composition of PM2.5 was determined by applying a chemical fractionation procedure followed by inductively-coupled plasma spectrometry analysis, with both optical emission and mass detection. The extractable, more bio-accessible fraction (ext), and the mineralised residual fraction (res) of each element were determined, thus increasing the selectivity of elements as source tracers. Indoor air in the considered apartments was affected by both outdoor pollution and specific indoor emission sources. The behaviour of each source was studied in detail, identifying a reliable tracer: Tires for soil, Asext for industrial sources, Vext for heavy oil combustion, Ce for cigarette smoking and Mo for the use of vacuum dust cleaners. Asext and Vext showed an excellent infiltration capacity, while the concentration of Tires was affected by a low infiltration capacity and by the contribution of particles re-suspension caused by the residents' movements. In the case of Ce and Mo, indoor concentrations were much higher than outdoor with a high variability among the apartments, due to the inhabitants' habits concerning cigarette smoke and use of electric appliances. To test the overall effect of the concomitant exposure to the identified sources on Wh12 M and on DDA, a WQS analysis was conducted. Cigarette smoking and heavily oil combustion driven the Wh12 M odds increase, while the DDA odds increase was mainly driven by heavily oil combustion and the use of vacuum dust cleaners.

Assessment of the link between atmospheric dispersion and chemical composition of PM10 at 2-h time resolution.

The concentration of air pollutants is governed by both emission rate and atmospheric dispersion conditions. The role played by the atmospheric mixing height in determining the daily time pattern of PM components at the time resolution of 2 h was studied during 21 days of observation selected from a 2-month field campaign carried out in the urban area of Rome, Italy. Natural radioactivity was used to obtain information about the mixing properties of the lower atmosphere throughout the day and allowed the identification of advection and stability periods. PM10 composition was determined by X-ray fluorescence, ion chromatography, inductively coupled plasma-mass spectrometry and thermo-optical analysis. A satisfactory mass closure was obtained on a 2-h basis, and the time pattern of the PM10 macro-sources (soil, sea, secondary inorganics, organics, traffic exhaust) was acquired at the same time scale. After a complete quality control procedure, 27 main components and source tracers were selected for further elaboration. On this database, we identified some groups of co-varying species related to the main sources of PM. Each group showed a peculiar behaviour in relation to the mixing depth. PM components released by soil, biomass burning and traffic exhaust, and, particularly, ammonium nitrate, showed a clear dependence on the mixing properties of the lower atmosphere. Biomass burning components and organics peaked during the night hours (around midnight), following the atmospheric stabilization and increased emission rate. Traffic exhausts and non-exhausts species also peaked in the evening, but they showed a second, minor increase between 6:00 and 10:00 when the strengthening of the emission rate (morning rush hour) was counterbalanced by the dilution of the atmosphere (increasing mixing depth). In the case of ammonium nitrate, high concentrations were kept during the whole night and morning.

A combined chemical/size fractionation approach to study winter/summer variations, ageing and source strength of atmospheric particles.

We studied the size distribution of ions (Cl-, NO3-, SO4=, Na+, NH4+, K+, Mg++, Ca++) and elements (As, Ba, Cd, Co, Cs, Cu, Fe, Li, Mn, Ni, Pb, Rb, Sb, Se, Sn, Sr, Ti, Tl, V, Zn) during the winter and summer seasons of seven consecutive years (2008-2014) in an area of the Po Valley (Northern Italy) characterised by industrial, agricultural and urban settings. The study included the collection and analysis of 41 series of size-segregated samples (MOUDI sampler, 10 stages, cut sizes from 0.18 to 18 µm). Ions were analysed by ion chromatography; elemental analysis was carried out by ICP-MS, by applying a chemical fractionation method able to increase the selectivity of PM source tracers. Our results indicate that important winter/summer variations occurred in both the concentration and size distribution of most PM components. These variations were explained in terms of variations in the strength of the prevailing sources of each component. The contribution of biomass burning for domestic heating was highlighted by the well-known tracer K+ but also by the soluble fraction of Rb, Cs and Li. Biomass burning contribution to atmospheric PM was mostly contained in the fine fraction, with a broad size-distribution from 0.18 to 1.8 µm. This source also appreciably increased the concentration of other elements in fine PM (As, Cd, Co, Mn, Pb, Sb, Sn). A few PM components (tracers of sea-spray, brake lining and some industries) did not show marked seasonal variations in concentration and size distribution. However, during winter, for brake lining and industry tracers we observed an upward shift in the dimension of fine particles and a downward shift in the dimension of coarse particles, due to the ageing of the air masses.

Biomass burning contribution to PM10 concentration in Rome (Italy): Seasonal, daily and two-hourly variations.

The possibility of a relevant contribution of biomass burning for domestic heating to PM10 in the urban area of Rome was explored. The concentration of levoglucosan was determined for 31 months in Rome and in a nearby peri-urban area. During the cold season it reached several hundreds of ng/m3 at both sites, with a clear inverse relationship with air temperature. During the summer it remained well below 100 ng/m3. Although at the peri-urban station the concentration was about 50% higher than at the urban site, the two seasonal patterns show a very good agreement (R2 = 0.95), pointing at a main contribution of biomass burning in both areas. Additional information came from the comparison of the 2-h time pattern of levoglucosan and the mixing conditions of the atmosphere, evaluated by monitoring natural radioactivity. During the summer levoglucosan concentration followed the pattern of natural radioactivity, indicating a contribution from many small sources scattered on a wide area (wildfires, barbecues, agricultural fires). During the heating season the activity of a source that switched in the early afternoon and switched off before midnight was highlighted. A 2-h delay between levoglucosan time patterns at the peri-urban and the urban site suggests that biomass burning mainly occurs outside Rome and the combustion products are then transported towards the city centre. Biomass burning contribution to PM10 was estimated as 12% at the peri-urban site and 6.7% inside the city, with relevant implications for the health of the about 2.800.000 citizens living in the urban area of Rome.

Correlación de hallazgos preoperatorios en la tomografía axial computarizada con la presencia de vía aérea difícil en pacientes intervenidos mediante cirugía otorrinolaringológica de cabeza y cuello / Correlation of preoperative findings in computed axial tomography with the presence of difficult airway in patients undergoing head and neck otorhinolaryngological surgery

Objetivos: Establecer una correlación entre 4 mediciones realizadas en la tomografía axial computarizada preoperatoria y la presencia de vía aérea difícil, y con la predicción clínica de la misma, en pacientes intervenidos mediante cirugía otorrinolaringológica. Material y métodos: Se realizó un estudio observacional, retrospectivo, usando como fuente de información las historias clínicas de 104 pacientes intervenidos bajo anestesia general e intubación endotraqueal por enfermedad oncológica durante un periodo de 36 meses. Sobre la base de los hallazgos obtenidos en las pruebas de imagen preoperatorias se realiza un análisis de regresión logística multivariante, donde las variables dependientes son grados extremos de visualización de la glotis (Cormack III-IV) o la presencia de predictores de intubación dificultosa (Mallampati III-IV). Se introdujeron en dicho modelo un total de 4 factores tomográficos y clínicos de vía aérea difícil. Resultados: En el grupo Cormack III-IV, en el modelo multivariante los resultados no fueron estadísticamente significativos cuando se comparaban con los predictores tomográficos (p>0,05; IC 95% distancia de la epiglotis a la pared faríngea posterior 0,030-2,31; distancia de la base de la lengua a la pared faríngea posterior 0,018-1,37). En el grupo Mallampati III-IV, en el modelo multivariante únicamente la distancia de las cuerdas vocales a la pared faríngea posterior muestra resultados clínicamente significativos (p<0,05; IC 95% 0,104-8,53). Conclusiones: En el abordaje de la vía aérea actualmente nos podemos apoyar en los predictores correspondientes al examen físico para adelantarnos a situaciones que pongan en riesgo la oxigenación y la ventilación de nuestros pacientes. Aunque aún los datos son insuficientes para recomendar las pruebas de imagen en este ámbito, parece que en un futuro pueden sumarse al examen físico para aumentar el rendimiento diagnóstico

Objectives: To establish a correlation between 4 measurements made on preoperative computed axial tomography and the presence of difficult airway, as well as its clinical prediction in patients undergoing otorhinolaryngological surgery. Material and methods: A retrospective, observational study was carried out using the information gathered from the clinical notes of 104 patients undergoing general anaesthesia and endotracheal intubation for oncological otorhinolaryngological surgery over a period of 36 months. Based on the findings in the preoperative imaging tests, a multivariate logistic regression analysis was performed, where the dependent variable was the presence of extreme grades of visualization of the glottis visualisation (Cormack III-IV) or the presence of predictors of difficult intubation (Mallampati III-IV). This resulted in a total of 4 tomographic and clinical factors of difficult airway being introduced in this model. Results: In the Cormack III-IV group, the results were not statistically significant in the multivariate model when compared to the tomography predictors, distance from epiglottis to posterior pharyngeal wall (95% CI; 0.030 - 2.31, P<.05), and the distance from the base of the tongue to the posterior pharyngeal wall (95% CI; 0.018-1.37, P<.05). In the Mallampati III-IV group, in the multivariate model only the distance from the vocal cords to the posterior pharyngeal wall showed clinically significant results (95% CI; 0.104 - 8.53, P<.05). Conclusions: In the approach to the airway, reliance on predictors is based on physical examination to anticipate situations that put oxygenation and ventilation of the patients at risk. There are still insufficient data to recommend imaging tests in this area, however it seems that in the future they may be added to the diagnostic performance of physical examination as predictors of difficult airway

Correlation of preoperative findings in computed axial tomography with the presence of difficult airway in patients undergoing head and neck otorhinolaryngological surgery. / Correlación de hallazgos preoperatorios en la tomografía axial computarizada con la presencia de vía aérea difícil en pacientes intervenidos mediante cirugía otorrinolaringológica de cabeza y cuello.

OBJECTIVES: To establish a correlation between 4 measurements made on preoperative computed axial tomography and the presence of difficult airway, as well as its clinical prediction in patients undergoing otorhinolaryngological surgery. MATERIAL AND METHODS: A retrospective, observational study was carried out using the information gathered from the clinical notes of 104 patients undergoing general anaesthesia and endotracheal intubation for oncological otorhinolaryngological surgery over a period of 36 months. Based on the findings in the preoperative imaging tests, a multivariate logistic regression analysis was performed, where the dependent variable was the presence of extreme grades of visualization of the glottis visualisation (Cormack III-IV) or the presence of predictors of difficult intubation (Mallampati III-IV). This resulted in a total of 4 tomographic and clinical factors of difficult airway being introduced in this model. RESULTS: In the Cormack III-IV group, the results were not statistically significant in the multivariate model when compared to the tomography predictors, distance from epiglottis to posterior pharyngeal wall (95% CI; 0.030 - 2.31, P<.05), and the distance from the base of the tongue to the posterior pharyngeal wall (95% CI; 0.018-1.37, P<.05). In the Mallampati III-IV group, in the multivariate model only the distance from the vocal cords to the posterior pharyngeal wall showed clinically significant results (95% CI; 0.104 - 8.53, P<.05). CONCLUSIONS: In the approach to the airway, reliance on predictors is based on physical examination to anticipate situations that put oxygenation and ventilation of the patients at risk. There are still insufficient data to recommend imaging tests in this area, however it seems that in the future they may be added to the diagnostic performance of physical examination as predictors of difficult airway.

Mínimo flujo de oxígeno necesario para soporte vital durante la simulación de reanimación post parada cardiorrespiratoria / Minimum oxygen flow needed for vital support during simulated post-cardiorespiratory arrest resuscitation

De acuerdo con las guías de la AHA y la ERC, la FiO2 a administrarse debería ser aquella con la que se obtuviera una SatO2 ≥ 94%. El objetivo de este estudio es determinar el mínimo flujo de oxígeno y tiempo necesarios para alcanzar una FiO2 de 0,32 y de 0,80 durante el manejo posparada cardiaca. Se emplearon diferentes reanimadores, que fueron conectados a un pulmón artificial: Mark IV, SPUR II, Revivator Res-Q, O-TWO. Los flujos de oxígeno probados fueron 2, 5, 10 y 15 lpm. Los test estadísticos aplicados fueron Bonferroni y U de Mann-Whitney. Se obtuvo una FiO2 ≥ 0,32 con cualquiera de los flujos de oxígeno y reanimadores. Tras un mínimo de 75 s ventilando con 2 o 5 lpm, solo se consiguió una FiO2 de 0,80 con Mark IV. Se hallaron diferencias clínica y estadísticamente significativas (p < 0,05): con 15 lpm se necesitaron 35 s para alcanzar una FiO2 ≥ 0,80 con Mark IV (85,6 [0,3]) y Revivator (84,3 [1,5]) comparado con los 50 s que precisó SPUR II (87,1 [6,4]); con 2 lpm, todos los resucitadores alcanzaron una FiO2 ≥ 0,32 en 30 s(Mark IV (34,8 [1,3]), Revivator (35,7 [1,5]) y SPUR II (34,4 [2,1]), excepto O-TWO, que necesitó 35 s (36,3 [4,3]). Para alcanzar una FiO2 de 0,32 se podría emplear cualquiera de los resucitadores usando 2 lpm, aunque quizá el menos recomendable sería O-TWO. Si el objetivo fuera una FiO2 de 0,80, debería bastar con 10 lpm, usando preferiblemente Mark IV o Revivator Res-Q. En conclusión, atendiendo a los resultados de nuestro estudio, ante cualquier situación potencial, sería preferible emplear Revivator Res-Q o Mark IV que O-TWO o SPUR II (AU)

According to the ERC and the AHA guidelines, FiO2 should be titrated to achieve an O2Sat ≥ 94%. The aim of this study was to determine the minimum oxygen flow and time needed to reach an FiO2 of 0.32 and 0.80 during post-cardiac arrest care. An experimental analysis was performed that consisted of a simulated post-cardiac arrest situation. Different resuscitators were tested and connected to an artificial lung: Mark IV, SPUR II, Revivator Res-Q, O-TWO. The oxygen flow levels tested were 2, 5, 10 and 15 lpm. Bonferroni and Mann-Whitney U tests were used. An FiO2 of 0.32 or more was obtained using any of the oxygen flow and resuscitators. Only the Mark IV achieved an FiO2 of 0.80 after a minimum of 75 s ventilating with 2 or 5 lpm. Clinical and statistical differences (P < .05) were found: at 15 lpm it took 35 s to reach an FiO2 of 0.80 or more for Mark IV (85.6 [0.3]) and Revivator (84.3 [1.5]) compared to 50 s for SPUR II (87.1 [6.4]); at 2 lpm, all of the devices reached an FiO2 of ≥ 0.32 at 30 s(Mark IV (34.8 [1.3]), Revivator (35.7 [1.5]) and SPUR II (34.4 [2.1]), except for O-TWO, which took 35 s (36.3 [4.3]). Patients could be ventilated with any of the resuscitators using 2 lpm to obtain an FiO2 of 0.32, although possibly O-TWO would be the last option during the first 60 s. In order to reach an FiO2 of 0.80, ventilating with 10 lpm should be sufficient, and preferably using Mark IV or Revivator Res-Q. In conclusion, on observing the results of our study, in any possible scenario, it would be advisable to use Revivator Res-Q or Mark IV rather than O-TWO or SPUR II (AU)

Minimum oxygen flow needed for vital support during simulated post-cardiorespiratory arrest resuscitation.

According to the ERC and the AHA guidelines, FiO2 should be titrated to achieve an O2Sat ≥ 94%. The aim of this study was to determine the minimum oxygen flow and time needed to reach an FiO2 of 0.32 and 0.80 during post-cardiac arrest care. An experimental analysis was performed that consisted of a simulated post-cardiac arrest situation. Different resuscitators were tested and connected to an artificial lung: Mark IV, SPUR II, Revivator Res-Q, O-TWO. The oxygen flow levels tested were 2, 5, 10 and 15 lpm. Bonferroni and Mann-Whitney U tests were used. An FiO2 of 0.32 or more was obtained using any of the oxygen flow and resuscitators. Only the Mark IV achieved an FiO2 of 0.80 after a minimum of 75s ventilating with 2 or 5 lpm. Clinical and statistical differences (P<.05) were found: at 15 lpm it took 35s to reach an FiO2 of 0.80 or more for Mark IV (85.6 [0.3]) and Revivator (84.3 [1.5]) compared to 50s for SPUR II (87.1 [6.4]); at 2 lpm, all of the devices reached an FiO2 of ≥ 0.32 at 30s(Mark IV (34.8 [1.3]), Revivator (35.7 [1.5]) and SPUR II (34.4 [2.1]), except for O-TWO, which took 35s (36.3 [4.3]). Patients could be ventilated with any of the resuscitators using 2 lpm to obtain an FiO2 of 0.32, although possibly O-TWO would be the last option during the first 60s. In order to reach an FiO2 of 0.80, ventilating with 10 lpm should be sufficient, and preferably using Mark IV or Revivator Res-Q. In conclusion, on observing the results of our study, in any possible scenario, it would be advisable to use Revivator Res-Q or Mark IV rather than O-TWO or SPUR II.

Chemical characterization of indoor and outdoor fine particulate matter in an occupied apartment in Rome, Italy.

The daily concentration and chemical composition of PM2.5 was determined in indoor and outdoor 24-h samples simultaneously collected for a total of 5 weeks during a winter and a summer period in an apartment sited in Rome, Italy. The use of a specifically developed very quiet sampler (<35 dB) allowed the execution of the study while the family living in the apartment led its normal life. The indoor concentration of PM2.5 showed a small seasonal variation, while outdoor values were much higher during the winter study. Outdoor sources were found to contribute significantly to indoor PM concentration especially during the summer, when the apartment was naturally ventilated by opening the windows. During the winter the infiltration of outdoor PM components was lower and mostly regulated by the particle dimensions. Organics displayed In/Out ratios higher than unity during both periods; their indoor production increased significantly during the weekends, where the family stayed mostly at home. PM components were grouped into macrosources (soil, sea, secondary inorganics, traffic, organics). During the summer the main contributions to outdoor PM2.5 came from soil (30%), secondary inorganics (29%) and organics (22%). Organics dominated both indoor PM2.5 during the summer (60%) and outdoor and indoor PM2.5 during the winter (51% and 66%, respectively).

Insulin resistance is associated with impaired cardiac sympathetic innervation in patients with heart failure.

AIMS: Insulin resistance (IR) represents, at the same time, cause and consequence of heart failure (HF) and affects prognosis in HF patients, but pathophysiological mechanisms remain unclear. Hyperinsulinemia, which characterizes IR, enhances sympathetic drive, and it can be hypothesized that IR is associated with impaired cardiac sympathetic innervation in HF. Yet, this hypothesis has never been investigated. Aim of the present observational study was to assess the relationship between IR and cardiac sympathetic innervation in non-diabetic HF patients. METHODS AND RESULTS: One hundred and fifteen patients (87% males; 65 ± 11.3 years) with severe-to-moderate HF (ejection fraction 32.5 ± 9.1%) underwent iodine-123 meta-iodobenzylguanidine ((123)I-MIBG) myocardial scintigraphy to assess sympathetic innervation and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) evaluation to determine the presence of IR. From (123)I-MIBG imaging, early and late heart to mediastinum (H/M) ratios and washout rate were calculated. Seventy-two (63%) patients showed IR and 43 (37%) were non-IR. Early [1.68 (IQR 1.53-1.85) vs. 1.79 (IQR 1.66-1.95); P = 0.05] and late H/M ratio [1.50 (IQR 1.35-1.69) vs. 1.65 (IQR 1.40-1.85); P = 0.020] were significantly reduced in IR compared with non-IR patients. Early and late H/M ratio showed significant inverse correlation with fasting insulinemia and HOMA-IR. CONCLUSION: Cardiac sympathetic innervation is more impaired in patients with IR and HF compared with matched non-IR patients. These findings shed light on the relationship among IR, HF, and cardiac sympathetic nervous system. Additional studies are needed to clarify the pathogenetic relationship between IR and HF.

Particulate matter concentration and chemical composition in the metro system of Rome, Italy.

Air quality at the main station of the metro system of Rome (Termini hub) has been characterized by the point of view of particulate matter (PM) concentration and chemical composition. Indoor air in different environments (underground train platform and shopping center, metro carriages with and without air conditioning system) has been studied and compared with outdoor air at a nearby urban site. Air quality at the railway station, located outdoor at surface level, has been also considered for comparison. PM chemical characterization included ions, elemental carbon, organic carbon, macro-elements, and the bio-accessible and residual fractions of micro- and trace elements. Train platform and carriages without air conditioning resulted to be the most polluted environments, with indoor/outdoor ratio up to two orders of magnitude for many components. PM mass concentration was determined on filter membranes by the gravimetric procedure as well as from the optical particle counter (OPC) number concentration measurements. The OPC results, taken with the original calibration factor, were below 40 % of the value obtained by the gravimetric measurements. Only a chemical and morphological characterization of the collected dust could lead to a reconciliation of the results yielded by the two methods. Macro-components were used to estimate the strength of the main macro-sources. The most significant contribution is confirmed to derive from wheels, rails, and brakes abrasion; from soil re-suspension (over 50 % at the subway platform); and from organics (about 25 %). The increase in the concentration of elements was mostly due to the residual fraction, but also the bio-accessible fraction showed a remarkable enrichment, particularly in the case of Ba, Zn, Cd, and Ni.

Seasonal variations in the chemical composition of particulate matter: a case study in the Po Valley. Part II: concentration and solubility of micro- and trace-elements.

Size distribution (fine and coarse fraction) and solubility distribution (extracted and residual fraction) of 20 elements (As, Ba, Be, Cd, Co, Cu, Fe, Li, Mn, Pb, Ni, Rb, S, Sb, Se, Sn, Sr, Ti, Tl, V) in atmospheric particulate matter (PM) were determined during a 5-year field study carried out in the Po Valley (peri-urban area of Ferrara, in Northern Italy). By studying the contribution of the two size fractions and the two solubility fractions to the atmospheric concentration of each element, it was possible to obtain interesting information about the variability of PM sources, to assess the role played by atmospheric stability in determining pollution episodes, and to obtain an estimate of the bio-accessible fraction. Atmospheric stability is confirmed to be one of the main causes of atmospheric pollution in this area and is to be responsible for the pronounced winter increase in both PM and elemental concentration. Long-range transport of natural and polluted air masses caused temporary increases in PM and elemental concentration, while local industrial emission seemed to play a secondary role. Regulated elements were well below their concentration limit, but many toxic elements were in the form of fine particles and soluble chemical species, more accessible to the environment, and the human body.

Seasonal variations in the chemical composition of particulate matter: a case study in the Po Valley. Part I: macro-components and mass closure.

The seasonal variability in the mass concentration and chemical composition of atmospheric particulate matter (PM10 and PM2.5) was studied during a 2-year field study carried out between 2010 and 2012. The site of the study was the area of Ferrara (Po Valley, Northern Italy), which is characterized by frequent episodes of very stable atmospheric conditions in winter. Chemical analyses carried out during the study allowed the determination of the main components of atmospheric PM (macro-elements, ions, elemental carbon, organic matter) and a satisfactory mass closure was obtained. Accordingly, chemical components could be grouped into the main macro-sources of PM: soil, sea spray, inorganic compounds from secondary reactions, vehicular emission, organics from domestic heating, organics from secondary formation, and other sources. The more significant seasonal variations were observed for secondary inorganic species in the fine fraction of PM; these species were very sensitive to air mass age and thus to the frequency of stable atmospheric conditions. During the winter ammonium nitrate, the single species with the highest concentration, reached concentrations as high as 30 µg/m(3). The intensity of natural sources was fairly constant during the year; increases in natural aerosols were linked to medium and long-range transport episodes. The ratio of winter to summer concentrations was roughly 2 for combustion product, close to 3 for secondary inorganic species, and between 2 and 3 for organics. The winter increase of organics was due to poorer atmospheric dispersion and to the addition of the emission from domestic heating. A similar winter to summer ratio (around 3) was observed for the fine fraction of PM.

Improved identification of transition metals in airborne aerosols by SEM-EDX combined backscattered and secondary electron microanalysis.

The SEM EDX backscattered electron (BSE) atomic number contrast has been largely used in this work, in combination with conventional secondary electron microanalysis, to investigate the presence of metal particles in airborne particulate collected at three sites (industrial, residential, and rural background) in the Po Valley (Italy). Individual particle x-ray microanalysis was used for this aim. In many cases, the presence of metal particles was not evident by secondary electron imaging and it was instead revealed by BSE detection. Metal particles were observed either as isolated (not clustered to other particles), or gathered together (homogeneous clusters). In addition, the BSE microanalysis put on evidence two main types of association of metals to other particulate components: heterogeneous clusters and metals embedded or enclosed in other materials. In this study, the first association (heterogeneous clusters) was observed mostly between Fe-bearing metallic particles and soot aggregates (or other carbonaceous particles) and it was found in the particulate matter (PM) of all studied sites. The second association, conversely, seems to be characterized by more selective relationships between composition/size of metal particles and type of other particulate components. These associations could be evidenced only when using the BSE Z-contrast and mainly concern three cases: (1) unusual silicate-carbonate mixed aggregates were observed at the industrial site only. In these aggregates, embedded Mn, Cr, Co, Bi, W, and Zr fine particles were selectively observed. (2) Ni and V rich ultrafine particles were only observed as embedded particles in the surface structure of carbon cenospheres. (3) Pb or Pb-Zn bearing fine and ultrafine particles were largely detected only in oxygenated organic aerosols in the ultrafine PM.

Resultados globales en un hospital privado sobre su modelo de gestión quirúrgica / Global results in a private hospital on its management model in day surgery an inpatient surgery

Introducción: El entorno actual pone de manifiesto la necesidad de encontrar modelos de gestión sanitaria con calidad, eficientes y seguros. Las unidades de cirugía mayor ambulatoria se han convertido en un modo de gestionar parte de la actividad quirúrgica con esas características. Actualmente, sin una forma de acreditarlas oficialmente, existen variaciones sobre unas recomendaciones mínimas, originando diferentes modelos, consecuencia de adaptar dicha gestión quirúrgica a las especiales características que cada centro hospitalario tiene. Material y métodos: Proponemos en el presente trabajo nuestro particular modelo de gestión quirúrgica, nacido de nuestras circunstancias, junto a los principales indicadores objetivos de actividad y de calidad, y que han originado el reconocimiento por parte de una auditoría externa tras valorar a 163 centros hospitalarios, de una manera voluntaria, gratuita y confidencial y en todo el territorio nacional. Resultados: Nuestro modelo de gestión quirúrgica que integra, tanto la cirugía sin ingreso como la ambulatoria, basado en modelos de actuación coordinados sobre la misma estructura física y organizativa ha propiciado que un hospital, de tan solo 90 camas, consiga realizar 17.366 intervenciones anuales en base a una tasa bruta de ambulatorización del 78-80 %, con unos índices de calidad superiores a la media de otros hospitales, de similares características; una tasa bruta de mortalidad del 1,3 (0,802 si la ajustamos por riesgo), una tasa de complicaciones del 1,7 (1,04 si la ajustamos por riesgo) y una tasa de readmisiones (..) (AU)

Introduction: The actual environment outlines the need of finding high quality management models that are efficient and safe. Ambulatory surgery facilities have become a way of managing part of the surgical activity with such features. Nowadays, with no means of formal accreditation, multiple variations exist on what should be considered minimum recommendations for this type of facility. This results in different models, as a consequence of adapting such surgical management to the special features that each hospital possesses. Materials and method: In our present study, we present our own surgical management model, adapted to fit our circumstances. We also present main objective quality indicators for surgical activity that have earned us recognition from an external audit that assessed 163 hospital facilities voluntarily, confidentially and wantonly across the country . Results: Our surgical management model includes day surgery and inpatient surgery and is based on performance models coordinated on the same physical and organizational structure. This has enabled a hospital facility of only 90 beds to achieve 17,366 surgeries a year, with a gross rate of ambulatory surgery of 70-80% and with quality indicators above the majority (..) (AU)

Opiniones y creencias sobre las enfermedades mentales graves (esquizofrenia y trastorno bipolar) en la sociedad española / Opinions and beliefs of the Spanish population on serious mental illnesses (schizophrenia and bipolar disorder)

Introducción:Conocer las opiniones, creencias y preocupaciones de la población general sobre dos enfermedades mentales graves: esquizofrenia y trastorno bipolar. Material y métodos:Se construyó un cuestionario ad-hoc para encuesta. Un panel de siete expertos extrajo los contenidos. También participaron: ASAENES, ABBA, FEAFES-ANDALUCIA, AMAFE, FEMASAM y AFAEM-5. El cuestionario contenía 12 preguntas sobre: conocimiento de las patologías, dificultades diagnósticas, síntomas, desencadenantes, interferencia, tratamientos y efectividad, creencias y preocupaciones. Administrado: IV Campaña de Concienciación Social sobre la Enfermedad Mental Grave (Madrid y Sevilla, septiembre - octubre 2009). Resultados:Se recogieron 5.473 encuestas, 55,8% en Sevilla. El 66,2% de la muestra eran mujeres y la edad media 35 años (DE=14,5). El 82% conocía ambas enfermedades, pero el 51% no conocía ningún síntoma de la esquizofrenia. Otras opiniones destacables: son difíciles de diagnosticar (59%), no se diagnostican por rechazo social (27%), interfieren bastante en la vida cotidiana (49%) o impiden la vida normal (42%), los tratamientos eficaces son psicológicos (82%) y farmacológicos (72%). Las creencias refieren: rechazo social, sobrecarga familiar y sufrimiento del paciente. Las preocupaciones refieren: peligrosidad, rechazo social, falta de información y escasez de recursos. Conclusiones:Existe desconocimiento sobre la sintomatología. La mayoría desconoce síntomas específicos y resalta los negativos. Se atribuye mayor eficacia al tratamiento conjunto psicológico-farmacológico. Preocupan la estigmatización y la sobrecarga familiar y personal(AU)

Introduction:To find out the opinions, beliefs and concerns of the Spanish population on serious mental diseases: schizophrenia and bipolar disorder. Material and methods:An ad-hoc questionnaire was constructed for the survey. A panel of seven experts extracted the contents. The Societies that involved were: ASAENES, ABBA, FEAFES-ANDALUCÍA, AMAFE, and AFAEM-5 advocacy societies were also involved. The questionnaire contained 12 questions about: knowledge of the diseases, diagnostic difficulties, symptoms, triggering factors, interference, treatments and effectiveness, beliefs and concerns. The questionnaire was administered during the IV Campaign of Social Awareness about Serious Mental Illness (Madrid and Seville, September-October 2009). Results:A total of 5,473 questionnaires were collected, 55.8% in Seville. The majority (66.2%) of the sample were women, and the mean age was 35 years (SD=14.5). Both illnesses were known by 82% of the population, but 51% did not known any symptom of schizophrenia. Other notable opinions were; they are difficult to diagnose (59%), they were not diagnosed due to social rejection (27%), interfered quite a lot with daily life (49%) or prevented a normal life (42%), the effective treatments are psychological (72%). Beliefs were: social rejection, family burden, and patient suffering. Concerns included: dangerousness, social rejection, lack of information, and scarcity of resources. Conclusions:There is a lack of knowledge of the symptoms. The majority do not know about specific symptoms and highlight the negative ones. Combined pharmacological-psychological treatment is believed to be most effective. Social stigma and family and personal burden are concerns(AU)

Determination of soluble ions and elements in ambient air suspended particulate matter: Inter-technique comparison of XRF, IC and ICP for sample-by-sample quality control.

In this paper, we describe a validation procedure for chemical fractionation analysis of elements (Al, As, Ba, Ca, Cd, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, S, Sb, Si, Sr, Ti and V) and soluble ions (Cl(-), NO(3)(-), SO(4)(2-), Na(+), NH(4)(+), Mg(2+), Ca(2+)) in suspended particulate matter (PM). The procedure applies three distinct measurement techniques (XRF, IC and ICP-OES) to the analysis of individual samples. The techniques used generate different outputs at different stages in the procedure. This makes it possible to identify the contributions of specific parameters to measurement uncertainty. On this basis, we propose a scheme for controlling the analytical quality of data from individual samples in which inter-technique comparisons is used in the same way many analytical methods use surrogates. We apply this scheme to about 310 samples of PM(10) and PM(2.5) identifying and assessing the main factors contributing to measurement uncertainty. This procedure successfully resolved a number of difficulties frequently encountered during the analysis of PM, including lack of appropriate reference materials and the low reliability of alternative techniques of quality control. The results demonstrate the critical importance of sample treatment prior to destructive analysis by IC and ICP.

Characterisation of gaseous and particulate atmospheric pollutants in the East Mediterranean by diffusion denuder sampling lines.

A field study aimed to characterize atmospheric pollutants in the gaseous and the particulate phases was conducted during the fall-winter of 2004 and the summer of 2005 in the Ashdod area, Israel. The site is influenced by both anthropogenic sources (power plants, refineries, chemical and metal industries, a cargo port, road traffic) and natural sources (sea-spray and desert dust). The use of diffusion lines--a series of annular diffusion denuders for sampling gaseous compounds followed by a cyclone and a filter pack for determining PM(2.5) composition--allowed a good daily characterization of the main inorganic compounds in both the gaseous (HCl, HNO(3), SO(2), NH(3)) and the particulate phase (Cl(-), NO(3)(-), SO(4)(=), NH(4)(+), and base cations). During the summer campaign two other activities were added: an intensive 3-h sampling period and the determination of PM(2.5) bulk composition. The results were interpreted on the basis of meteorological condition, especially the mixing properties of the lower atmosphere as determined by monitoring the natural radioactivity due to Radon progeny, a good proxy of the atmospheric ability to dilute pollutants. Several pollution episodes were identified and the predominance of different sources was highlighted (sea-spray, desert dust, secondary photochemical pollutants). During the summer period a considerable increase of nitric acid and particulate sulphate was observed. Secondary inorganic pollutants (nitrate, sulphate and ammonium) constituted, on the average, 57% of the fine particle fraction, organic compounds 20%, primary anthropogenic compounds 14%, natural components (sea-spray and crustal elements) 9%. The advantages of the diffusion lines in determining gaseous and particulate N- and S- inorganic compounds are discussed.