Coronavirus disease 2019 (COVID-19) pandemic is quickly spreading, putting under heavy stress health systems worldwide and especially Intensive Care Units (ICU). Rehabilitation Units have a crucial ...role in reducing disability in order to reintroduce patients in the community.
The aim of this study is to characterize pulmonary function and disability status and to propose an early rehabilitation protocol in a cohort of post-acute COVID-19 patients admitted to an Italian Rehabilitation Unit.
Cross-sectional observational study.
Inpatients Rehabilitation Unit.
Post-acute COVID-19 patients.
Demographic, anamnestic and clinical characteristics, laboratory exams and medical imaging findings were collected for the entire cohort. Outcome measures evaluated at the admission in Rehabilitation Unit were: type of respiratory supports needed, fraction of inspired oxygen (FiO2), partial pressure of oxygen (PaO2), FiO2/PaO2, Barthel Index (BI), modified Medical Research Council (mMRC) Dyspnoea Scale, and 6-Minute Walking Test (6-MWT). Furthermore, we proposed an early rehabilitation protocol for COVID-19 patients based on baseline FiO2.
We included 32 post-acute COVID-19 patients (22 male and 10 female), mean aged 72.6±10.9 years. BI was 45.2±27.6, with patients in need of higher FiO2 (≥40%) showing lower values: 39.6±25.7 vs. 53.3±29.3. All patients had grade 4 or 5 on the mMRC Dyspnea Scale. Only 14 COVID-19 patients were able to walk (43.7%). 6-MWT was feasible in 6 (18.8%) patients with a mean distance of 45.0±100.6 meters.
Taken together, our findings suggest that post-acute COVID-19 patients suffered from dyspnea and shortness of breath even for minimal activities, with a resulting severe disability, and only a few of them were able to perform 6-MWT with poor results. An early rehabilitation protocol was proposed according to the baseline conditions of the patients.
This study could provide an accurate description of COVID-19 sub-acute patients admitted to a Rehabilitation Unit along with a proposal of treatment to help physicians to tailor the best possible rehabilitative treatment.
High levels of PCBs were recently found in soil, food and some farmers living close to a chemical factory which until the 1980s had produced polychlorinated biphenyls (PCBs) in Brescia, North Italy.
...We performed a survey on a random sample of subjects aged 20–79 years living in various areas of the town with different levels of soil pollution to investigate factors associated with increased levels of PCB in serum (24 congeners were tested).
Total PCB values were closely related to age (Spearman
r
=
0.68;
p
<
0.0001). The 166 consumers of locally produced food had higher PCB levels than non-consumers (median
=
1143 versus 719; 95th centile
=
9301 versus 2635
ng/g lipid) with the highest levels among consumers of food produced in the most contaminated area close to the factory (median
=
2551; 95th centile
=
33
464
ng/g lipid). A dose-effect relationship between consumption of food produced in this area and PCB blood levels was observed (Spearman
r
=
0.52,
p
=
0.0014). Consumers of only plant food produced in this area had higher levels of PCB than non-consumers (median
=
1100; 95th centile
=
10
800
ng/g lipid). Three subjects who had worked at the factory in the past showed high PCB levels.
Distribution of PCB congeners did not differ between consumers of locally produced food and non-consumers, apart from PCB 209 which was found at high levels in former factory workers and was more common among consumers of food produced in the polluted area.
In conclusion, we found high serum PCB levels in humans living in a highly polluted area in an industrialized town in Italy, due mainly to consumption of food produced in polluted areas.
Background. Polychlorinated biphenyls (PCBs) have been recognized as human carcinogens and cause liver cancer in animal experimental studies. However, no study investigated their association with ...hepatocellular carcinoma (HCC) so far. This study aimed to evaluate the serum PCB concentration in HCC patients and in healthy subjects of the general population living in Brescia, North Italy, a highly industrialized area with heavy PCB environmental pollution due to the presence of a PCB producing factory. Methods. Lipid-adjusted PCB concentrations, computed as the sum of 24 congeners, were measured in the serum of 101 HCC patients and in 101 healthy subjects of the same age and gender. Results. Hepatitis B and C virus infection and history of heavy alcohol intake were found, alone and combined, in 87% of HCC patients. No difference was found in PCB serum concentration of HCC patients with and without, and according to, the major risk factors for liver disease. No significant difference was observed in serum total PCB concentration between HCC patients (median: 1081; range: 287.0-3182.0 ng/g lipid) and healthy subjects (median: 1199.3; range: 225.7-22825 ng/g lipid). PCB congeners 118, 138, 153, 156, 180 and 194 were the only ones found over the detection limit in at least 30% of HCC patients. The serum level of PCB 118, but not that of other congeners, was higher in HCC patients than in healthy subjects. Conclusion. These findings do not support the hypothesis that PCBs play an important role in HCC development, although a contribution by some specific congeners cannot be ruled out.
Background
Polychlorinated biphenyls (PCBs) have been found to be associated with diabetes in some, but not all, studies performed so far. The aim of this study was to assess the association between ...PCB serum levels and glycaemia and diabetes in people living in Brescia, a highly industrialised PCB-polluted town in Northern Italy.
Design and Methods
527 subjects were enrolled in a cross-sectional population-based study: they were interviewed face-to-face in 2003 and also provided a blood sample under fasting conditions. The concentration of 24 PCB congeners was determined using gas-chromatography (GC/MS). Subsequently, all subjects were included in a follow-up (cohort) study. According to the Local Health Authority health-care database, subjects were considered to be diabetic if they had diabetes at interview time (prevalent cases) or during a 7-year follow-up (incident cases).
Results
A total of 53 subjects (10.0%) were diabetics: 28 had diabetes at enrolment and other 25 developed the disease subsequently. Diabetes frequency increased according to the serum concentrations of total PCBs and single PCB congeners, but no association was found when estimates were adjusted for education, body mass index, age and gender by logistic regression analysis. Accordingly, glycaemia increased with PCB serum levels, but no association was observed when multiple regression analysis, including confounding factors, was performed.
Conclusions
This study does not support the hypothesis that PCB environmental exposure is strictly associated with diabetes or glycaemia.
This study was designed to evaluate both levels and distributions of organochlorine pollutants in placenta and other maternal–foetal tissues, from women resident in an Italian highly industrialized ...urban area with demonstrated PCB pollution.
To this end, 30 polychlorinated biphenyl congeners (PCBs), p,p′-dichlorodiphenyltrichloroethane (p,p′-DDT), p,p′-dichlorodiphenyldichloroethylene (p,p′-DDE) and hexachlorobenzene (HCB), were determined in placenta, both maternal and cord blood serum and adipose tissue of Caucasian pregnant women (
n
=
70) undergoing to programmed caesarean delivery.
Median placental concentrations of PCBs, p,p′-DDE and HCB (0.89
ng
g
−1, 0.63
ng
g
−1 and 0.19
ng
g
−1 on wet tissue weight basis, respectively), were lower than previously published data. p,p′-DDT could be detected in most of adipose tissue samples, but very rarely in the other compartments.
Distributions of investigated compounds in biological matrices showed significant relationships, confirming their transplacental transfer. It is worthy of note that HCB tended to be transferred more easily from maternal to foetal tissues.
Maternal serum levels of these pollutants can allow a reliable estimation of organochlorine compound body burden, and can be useful markers of prenatal exposure, given their relationships with placental and umbilical cord serum levels.
Some organochlorine compounds, such as polychlorinated biphenyls (PCBs), have a tendency to bioaccumulate in humans and predators at the top of the food chain. We have recently confirmed the ...transplacental transfer of these compounds and the present study has been designed on the same material with the aim of investigating their potential health effects on newborns from 70 pregnant women, resident in a Northern Italy industrial town. Organochlorine compounds namely, p,p′-dichlorodiphenyltrichloroethane (p,p′-DDT), p,p′-dichlorodiphenyldichloroethene (p,p′-DDE), hexachlorobenzene (HCB), and PCBs have been analyzed both in cord and maternal serum, placenta, and maternal subcutaneous adipose tissue by GC-MSD. p,p′-DDT levels in the adipose tissue resulted significantly (
p
<
0.05) related to birth length. Mothers of neonates born by preterm programmed caesarean delivery showed significantly (
p
<
0.005 for both) higher serum p,p′-DDE serum concentrations and p,p′-DDT levels in the adipose tissue, as compared to mothers delivering at term.
► Documented prenatal exposure to PCBs in an Italian polluted urban area ► Detectable levels of POPs in placenta and umbilical cord serum ► Higher concentrations of p,p′-DDE in premature newborns ► No evidence of an association between prenatal exposure to POPs and birth weight
► 101 HCC cases living in highly PCBs-polluted area were enrolled. ► PCBs were measured in serum, liver and fat of 59 cases who underwent surgery. ► Close correlations were found among three tissues. ...► Lipid-adjusted serum PCBs level is a valid measure of PCBs body burden.
Brescia (North Italy) is located in a highly industrialized area with diffuse environmental pollution by polychlorinated biphenyls (PCBs) and with a high incidence of hepatocellular carcinoma (HCC). We aimed to investigate the concentration of PCBs congeners in serum, liver and adipose tissue of patients with HCC living in this area.
We enrolled prospectively 101 HCC incident cases. Lipid-adjusted PCBs concentration of single congeners and total PCBs concentration, computed as the sum of 24 PCBs congeners, were measured in the serum of all subjects and in the liver and abdominal fat of 59 HCC cases undergoing surgery.
A high correlation was found between PCBs serum and liver (Spearman r=0.79), serum and fat (r=0.91), and liver and fat (r=0.75) concentrations. Serum PCBs concentration in HCC patients did not vary according to demographical, clinical or epidemiological variables, apart from age, as PCBs concentration increased linearly with the subject’s age. This study confirms that serum lipid-adjusted PCBs concentration is a valid measure of PCBs body storage and is highly correlated with PCBs concentration detected in other biological samples.
A chemical factory which produced polychlorinated biphenyls (PCBs) operated in Brescia, North Italy, (about 200
000 inhabitants) from the 1930s to the 1980s. High levels of PCBs were recently found ...in soil, food and people living in an area close to the factory. We performed a survey among the general population living in non-polluted areas of the town in order to define the reference values (RVs) of the non-exposed population. A random sample of subjects aged 20–79 years (50% males) was selected. Participants underwent PCB determination and were interviewed on their residential and occupational history and current diet. For RV determination, subjects who had resided in the polluted area or consumed any food produced in the area in their lifetime were excluded. Eight hundred and ninety-two subjects were contacted, 579 (65%) of whom agreed to participate; 311 of them were considered for RV determination (53% male, mean age
=
48.7 years). Total PCB serum levels, computed as the sum of the 24 congeners determined, were: mean
=
5.15
ng/ml (SD
=
8.83), median
=
4.11
ng/ml, range
=
0.4–34.12
ng/ml, 95th centile
=
14.38
ng/ml. Lipid-adjusted mean and median were 897 and 705
ng/g lipid, respectively. PCB values showed positive correlations with age (Spearman’s
r
=
0.76) and with serum concentration of total cholesterol (
r
=
0.40) and triglycerides (
r
=
0.36). No association was found with gender, cigarette smoking, alcohol or diet. Seven PCB congeners, (PCB 180, 153, 138, 170, 194, 118, and 156), including those at higher chlorination, were present in more than 30% of the subjects and contributed 99% of the total PCB levels, with a modest role of dioxin-like congeners.
The aim of the present study was to investigate whether exhaled breath condensate (EBC), a fluid formed by cooling exhaled air, can be used as a suitable matrix to assess target tissue dose and ...effects of inhaled cobalt and tungsten, using EBC malondialdehyde (MDA) as a biomarker of pulmonary oxidative stress. Thirty-three workers exposed to Co and W in workshops producing either diamond tools or hard-metal mechanical parts participated in this study. Two EBC and urinary samples were collected: one before and one at the end of the work shift. Controls were selected among nonexposed workers. Co, W, and MDA in EBC were analyzed with analytical methods based on mass spectrometric reference techniques. In the EBC from controls, Co was detectable at ultratrace levels, whereas W was undetectable. In exposed workers, EBC Co ranged from a few to several hundred nanomoles per liter. Corresponding W levels ranged from undetectable to several tens of nanomoles per liter. A parallel trend was observed for much higher urinary levels. Both Co and W in biological media were higher at the end of the work shift in comparison with preexposure values. In EBC, MDA levels were increased depending on Co concentration and were enhanced by coexposure to W. Such a correlation between EBC MDA and both Co and W levels was not observed with urinary concentration of either element. These results suggest the potential usefulness of EBC to complete and integrate biomonitoring and health surveillance procedures among workers exposed to mixtures of transition elements and hard metals.
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