Effects of short-term exposure to particulate matter on emergency department admission and hospitalization for asthma exacerbations in Brescia district.

BACKGROUND: Rising pollution plays a crucial role in worsening several respiratory diseases. Particulate Matter (PM)-induced asthma exacerbations are one of the most dangerous events. OBJECTIVES: To assess the correlation between progressive particulate matter short-term exposure and asthma exacerbations, we investigated the role of PM levels on Emergency Department (ED) admissions and hospitalizations for these events in Brescia, an important industrial city located in northern Italy with high yearly levels of air pollution. METHODS: We analyzed 1050 clinical records of ED admissions for suspected asthma exacerbation, starting from January 2014 to December 2017. Daily PM levels were collected from the Environmental Protection Regional Agency. We performed a time-series analysis using a Poisson regression model with single and multiple day-lag. Results were expressed as Relative Risk (RR) and Excess of Relative Risk (ERR) of severe asthma exacerbation over a 10 µg/m3 increase in PM10 and PM2.5 concentration. RESULTS: We selected and focused our analysis on 543 admissions for indisputable asthma exacerbation in ED and hospital. The time-series study showed an increase of the RR (CI95%) for asthma exacerbation-related ED admissions of 1.24 with an ERR of 24.2% for PM2.5 at lag0-1 (p < 0.05). We also estimated for PM2.5 a RR (CI95%) of 1.12 with an ERR of 12.5% at lag0-5 (p ≤ 0.05). Again, for PM2.5, an increase of the RR (CI95%) for asthma exacerbation-related hospitalizations of 1.31 with an ERR of 30.7% at lag0-1 (p < 0.05) has been documented. These findings were confirmed and even reinforced considering only the population living in the city. CONCLUSIONS: Short-term PM exposure, especially for PM2.5, plays a critical role in inducing asthma exacerbation events leading to ED admission or hospitalization.

Recurrent Ventricular Arrhythmia Caused by Ingestion of Aconitum (Monkshood) Flowers.

We report the case of a patient who presented with respiratory failure, recurrent ventricular fibrillation, ventricular arrhythmias, and hypotension after an intentional ingestion of aconite flowers. Significant ingestion of this plant can produce life-threatening cardio- and neurotoxicity that may require evacuation from the wilderness to a medical facility capable of advanced treatment and intensive care monitoring.

Emergency department admission and hospitalization for COPD exacerbation and particulate matter short-term exposure in Brescia, a highly polluted town in northern Italy.

BACKGROUND: Short-term exposure to high Particulate Matter (PM) concentrations worsens several respiratory conditions. OBJECTIVES: We evaluated the relationship between short-term exposure to Particulate Matter and fine Particulate Matter (PM10 - PM2.5) and Emergency Department (ED) admissions and hospitalizations for COPD exacerbation observed at the University Hospital, Spedali Civili of Brescia, a city with some of the highest yearly levels of air pollution in Italy. METHODS: We collected data from patients admitted to the ED with a COPD exacerbation diagnosis, starting from January 2014 to January 2016. Daily PM levels were collected from the Environmental Protection Regional Agency (ARPA). We performed a time-series analysis using the Poisson regression model with single and multiple day-lag. Results were expressed as Relative Risk (RR) and Excess of Relative Risk (ER) for COPD exacerbation-related ED admissions and hospitalizations, over a 10µg/m3 increase in PM concentration. RESULTS: We collected data from 431 COPD patients. Both PM10 and PM2.5 were significantly associated with the risk of COPD exacerbation-related ED admission and hospitalization. Each increase of 10µg/m3 of PM10 and PM2.5 corresponded respectively to a RR for ED admissions of 1.06 and 1.08 at lag0-1; 1.06 and 1.09 at lag0-5 (p < 0.05). Similar results for COPD Exacerbation-related hospitalizations were found, with a RR of 1.07 and 1.10 at lag0-1 and 1.07 and 1.11 at lag0-5 for each increase of 10µg/m3 PM10 and PM2.5, respectively. CONCLUSIONS: Our findings show that in a highly polluted city of Northern Italy, short-term increase in exposure to PM10-PM2.5 is associated with a higher risk of ED admission and hospitalization due to COPD exacerbation with a greater incidence during the winter season.

Neurological diseases and health care utilization among first-generation immigrants.

Migrants may constitute a risk group and should have specific targets for health policy. To identify their health needs, it is important to investigate their epidemiological profile and their access to health services. The aim of this study was to identify the pattern of hospital and neurological services use among immigrants living in Brescia (Italy). The analysis took into account the records of 45,645 immigrants admitted to the ER (Emergency Room) as well as the discharge data of 6419 patients hospitalized in the Department of Neurology of the Azienda Ospedaliera Spedali Civili di Brescia, over a 3.5 years period. To take confounding factors into account, immigrant patients admitted to the department of Neurology were compared to a selection of Italian patients matched by age and sex. The main objectives were to explore causes of admission of the immigrant population-along with socio-demographic characteristics-to the Emergency Room and to the Neurology Units. Immigrants showed a similar pattern of hospital use to the Italian patients, although with a higher frequency of infective diseases and traumatic injuries. They also showed a higher mean Diagnosis-Related Group (DRG) weight than the Italians. Average length of hospitalization was longer in immigrant population. However, the use of neurological services by migrants is less than their demographic share. Poorer economic and social conditions, as well as a worse labor market experienced by immigrants may expose them to risk factors for injuries and infective diseases. Reducing the language and bureaucratic barriers, as well as enhancing cross-cultural skills of physicians, might be crucial in decreasing the length and the cost of hospitalization.