Beneficial effect of corticosteroids in preventing mortality in patients receiving tocilizumab to treat severe COVID-19 illness.

OBJECTIVES: To assess the characteristics and risk factors for mortality in patients with severe coronavirus disease-2019 (COVID-19) treated with tocilizumab (TCZ), alone or in combination with corticosteroids (CS). METHODS: From March 17 to April 7, 2020, a real-world observational retrospective analysis of consecutive hospitalized adult patients receiving TCZ to treat severe COVID-19 was conducted at our 750-bed university hospital. The main outcome was all-cause in-hospital mortality. RESULTS: A total of 1,092 patients with COVID-19 were admitted during the study period. Of them, 186 (17%) were treated with TCZ, of which 129 (87.8%) in combination with CS. Of the total 186 patients, 155 (83.3 %) patients were receiving noninvasive ventilation when TCZ was initiated. Mean time from symptoms onset and hospital admission to TCZ use was 12 (±4.3) and 4.3 days (±3.4), respectively. Overall, 147 (79%) survived and 39 (21%) died. By multivariate analysis, mortality was associated with older age (HR = 1.09, p < 0.001), chronic heart failure (HR = 4.4, p = 0.003), and chronic liver disease (HR = 4.69, p = 0.004). The use of CS, in combination with TCZ, was identified as a protective factor against mortality (HR = 0.26, p < 0.001) in such severe COVID-19 patients receiving TCZ. No serious superinfections were observed after a 30-day follow-up. CONCLUSIONS: In patients with severe COVID-19 receiving TCZ due to systemic host-immune inflammatory response syndrome, the use of CS in addition to TCZ therapy, showed a beneficial effect in preventing in-hospital mortality.

Potential sources and meteorological factors affecting PM2.5-bound polycyclic aromatic hydrocarbon levels in six main cities of northeastern Italy: an assessment of the related carcinogenic and mutagenic risks.

A yearlong sampling campaign (2012-2013) was conducted in six major cities of the Veneto region to investigate the spatial-temporal trends and the factors affecting the polycyclic aromatic hydrocarbon (PAHs) variations and identify the local sources. Sixty samples per city were collected for analyses in every alternate month (April, June, August, October, December, and February): 10 samples per sampling site in 10 consecutive days of the months selected. Samples were ultrasonically extracted with acetonitrile and processed through high-performance liquid chromatography. Total Σ-PAH concentrations ranged from 0.19 to 70.4 ng m-3 with a mean concentration of 11.5 ng m-3. The mean benzo[a]pyrene (BaP) concentration reached 2.0 ng m-3, which is two-times higher than the limit set by the European Union. BaP contributed for 17.4% to the total concentration of PAHs, which showed the same pattern across the region with maxima during cold months and minima in the warm period. In this study, PAHs showed an inverse relationship with temperature, solar radiation, wind speed, and ozone. According to this study, biomass burning for household heating and cooking, followed by gaseous PAHs absorption on particles due to low atmospheric temperature, were the main reasons for increasing PAHs concentration in winter. Health risk, evaluated as lifetime lung cancer risk (LCR), showed a potential carcinogenic risk from the airborne BaPTEQ six-fold higher in the cold season than in the warm one. Diagnostic ratios and conditional probability functions were used to locate the sources, and results confirmed that local emission, overall domestic heating, and road transport exhausts were responsible for higher concentration rates of PAHs as well as of PM2.5.

The dark side of the tradition: the polluting effect of Epiphany folk fires in the eastern Po Valley (Italy).

In the Veneto Region (Po Valley, Northeastern Italy) on the eve of Epiphany, an important religious celebration, during the night between January 5th and 6th thousands of folk fires traditionally burn wooden material. The object of this study is to characterize the 2013 episode, by monitoring the effects on the air quality in the region's lowlands. The daily concentrations of PM2.5 and PM10 exceeded 250 and 300 µg m(-3), respectively and the PM10 hourly values were above 600 µg m(-3) in many sites. The levels of total carbon, major inorganic ions, polycyclic aromatic hydrocarbons and biomass burning tracers (levoglucosan and K(+)) were measured in 84 samples of PM10 and 38 of PM2.5 collected at 32 sites between January 4th and 7th. Total carbon ranged from 11 µg m(-3) before the pollution episode to 131 µg m(-3) a day afterwards, K(+) from 0.6 to 5.1µg m(-3), benzo(a)pyrene from 2 to 23 ng m(-3), and levoglucosan from 0.5 to 8.3 µg m(-3). The dispersion of the particulate matter was traced by analyzing the levels of PM10 and PM2.5 in 133 and 51 sites, respectively, in the Veneto and neighboring regions. In addition to biomass burning the formation of secondary inorganic aerosol was revealed to be a key factor on a multivariate statistical data processing. By providing direct information on the effects of an intense and widespread biomass burning episode in the Po Valley, this study also enables some general considerations on biomass burning practices.