Carmela Protano

A tobacco-related carcinogen: assessing the impact of smoking behaviours of cohabitants on benzene exposure in children

Background Secondhand smoke (SHS) represents a major preventable cause of morbidity for communities, especially for children, who are more susceptible than adults to the adverse effects of passive smoking. SHS contains several carcinogens, including benzene. Objective To investigate the role of household characteristics and the smoking behaviours of cohabitants in predicting SHS-derived benzene exposure levels. Methods In this cross-sectional study, 122 children (aged 5–11 years old) were selected from a school in rural Italy. Characteristics of their home environment and the smoking habits of the childrens cohabitants were obtained via questionnaire, and urinary unmodified benzene (u-UB) and cotinine (a specific nicotine metabolite) levels were determined from spot urine samples. Results Significant differences between SHS-exposed and SHS-unexposed children were found with respect to u-UB levels (median values 359.50 and 92.50 ng/litre, respectively; p<0.001). The excretion of u-UB increased significantly in parallel to increased SHS exposure as follows: unexposed to SHS (median value 92.50 ng/litre)<cohabitant(s) smoker(s) not smoking inside the home (282.00 ng/litre)<cohabitant(s) smoking inside the home only when children are out (314.50 ng/litre)<cohabitant(s) smoking inside the home even when children are in (596.00 ng/litre). The difference between groups was significant (p=0.019). Conclusions Although smoke-free legislation has transformed the smoking behaviours of some, domestic environments remain an important source of SHS exposure for children. This fact holds true even in the case of parents and other cohabitants who believe they are fully protecting children by smoking only outdoors or at home only when the children are not present. These findings should be included in Italian community-level health promotion interventions for discouraging tobacco use.

Urinary trans, trans-muconic acid and S-phenylmercapturic acid are indicative of exposure to urban benzene pollution during childhood ☆

The aims of the study were to evaluate the feasibility of urinary trans, trans-muconic acid (u-t,t-MA) and urinary S-phenylmercapturic acid (u-SPMA) as markers of exposure to urban benzene pollution for biomonitoring studies performed on children and to investigate the impact that creatinine correction may have on the classification of children exposure status. U-t,t-MA, u-SPMA, u-cotinine, and u-creatinine levels were measured in urine samples of 396 Italian children (5-11 years) living in three areas with different degrees of urbanisation (very, fairly and non-urban). The median u-SPMA levels significantly increased with increased urbanisation: non-urban (0.19 μg/L; 0.22 μg/g creatinine)<fairly urban (0.28 μg/L; 0.28 μg/g creatinine)<very urban group (0.92 μg/L; 0.90 μg/g creatinine). Differences in the levels of u-t,t-MA excretion related to the degree of urbanisation were revealed only by multivariate analyses. Neither u-SPMA nor u-t,t-MA levels were influenced by environmental tobacco smoke (ETS) exposure. Athletic activity during the sampling day was negatively associated with u-SPMA in the model built with u-SPMA adjusted for creatinine, but not in the model where unadjusted u-SPMA was used. This finding demonstrates that u-creatinine correction may alter the results when an independent variable is unrelated to the chemical concentration itself but is related to the u-creatinine levels. These results suggest that both u-SPMA and u-t,t-MA are indicative for assessing environmental benzene exposure in children (exposed and unexposed to ETS) when urine sample is collected at the end of the day. However, u-SPMA is more reliable because u-t,t-MA, also a metabolite of sorbic acid, is less specific for exposure to low levels of benzene. To avoid the possible confounding effect of creatinine correction, it is better to use u-creatinine as additional independent variable in multiple linear regression analyses for evaluating the independent role of the covariates on the variability of u-t,t-MA and u-SPMA levels.

Performance of Different Work Clothing Types for Reducing Skin Exposure to Pesticides During Open Field Treatment

The aim of this study was to estimate the performance of different work clothing types for reducing skin exposure to five pesticides (azinphos-methyl, terbutylazine, alachlor, dimethoate, and dicamba) in field distribution by tractor equipped with boom sprayer. Performance was assessed by measuring the penetration factors of different types of work clothing. The results show that the protection offered by personal protective equipment (PPE) was always >97%, whereas the performance of cotton garments ranged from 84.1% to 92.5%. The different cotton garments differed significantly in their permeability, and the upper part of the body was the anatomical region showing the greatest values of the penetration factors. These results confirm the necessity of using PPE properly to minimise dermal exposure to pesticides.

Second-hand smoke generated by combustion and electronic smoking devices used in real scenarios: Ultrafine particle pollution and age-related dose assessment

Aerosol measurements were carried out in a model room where both combustion (conventional and hand-rolled cigarettes, a cigar and tobacco pipe) and non-combustion (e-cigarette and IQOS®) devices were smoked. The data were used to estimate the dose of particles deposited in the respiratory systems of individuals from 3months to 21years of age using the multiple-path particle dosimetry (MPPD) model. Regardless of the smoking device, the highest doses were received by infants, which reached 9.88×108particles/kg bw during a cigar smoking session. Moreover, 60% to 80% of the particles deposited in the head region of a 3-month-old infant were smaller than 100nm and could be translocated to the brain via the olfactory bulb. The doses due to second-hand smoke from electronic devices were significantly lower, below 1.60×108particles/kg bw, than those due to combustion devices. Dosimetry estimates were 50% to 110% higher for IQOS® than for e-cigarettes.

Urinary levels of trace elements among primary school-aged children from Italy: The contribution of smoking habits of family members

The aims of the present study was to investigate the role of Environmental Tobacco Smoke (ETS) exposure in domestic environment, the smoking policies adopted at home on urinary excretion of 23 trace elements present in tobacco and/or tobacco smoke (Li, Be, B, Ti, V, Cr, Mn, Co, Ni, Cu, Zn, Ga, Rb, Sr, Cd, Sn, Sb, Te, Cs, Tl, Pb, Bi, U) among a sample of healthy Italian school-aged children. The levels of monitored trace elements in urine samples from 110 children (5-11years) living in a rural area and recruited in a cross-sectional study were measured via inductively coupled plasma mass spectrometry, while information regarding demographic characteristics and ETS exposure of the participants were obtained from questionnaires. Univariate elaborations evidenced that Co and Mn levels increased in children exposed to ETS in domestic environment, but multiple linear regression analyses revealed the independent effect of the habit of cohabitant(s) smoker(s) of smoking at home when children is present on urinary concentrations of Li, Ti, V, Co, Ga and Sr. Besides, we found significant gender- and age-dependency of some monitored elements: females presented higher Cu and Pb levels, but lower Rb levels respect to males, while age displayed a significant negative independent effect on the Cr, Co, Rb, and Sn concentrations, but positive on Ga levels. Finally, u-creatinine was a significant predictor for almost all the analytes, but not for Mn, Cd, Sb, Ga.

Second-hand smoke exposure generated by new electronic devices (IQOS® and e-cigs) and traditional cigarettes: submicron particle behaviour in human respiratory system

Passive exposure profiles to submicronic particles (SMPs, 5.6-560 nm) of traditional cigarettes and new electronic commercial devices (e-cig and IQOS®, a new heat-not-burn smoking device) were compared. During smoking, SMPs released by traditional cigarettes resulted four-times higher than those released by electronic and heat-not-burn devices and remained high for at least one hour, while SMPs values returned immediately similar to background for electronic and heat-not-burn devices. In all experiments, approximately half of SMPs resulted so small to reach the alveolar region.

Temporal evolution of ultrafine particles and of alveolar deposited surface area from main indoor combustion and non-combustion sources in a model room

Aerosol number size distributions, PM mass concentrations, alveolar deposited surface areas (ADSAs) and VOC concentrations were measured in a model room when aerosol was emitted by sources frequently encountered in indoor environments. Both combustion and non-combustion sources were considered. The most intense aerosol emission occurred when combustion sources were active (as high as 4.1×107particlescm-3 for two meat grilling sessions; the first with exhaust ventilation, the second without). An intense spike generation of nucleation particles occurred when appliances equipped with brush electric motors were operating (as high as 106particlescm-3 on switching on an electric drill). Average UFP increments over the background value were highest for electric appliances (5-12%) and lowest for combustion sources (as low as -24% for tobacco cigarette smoke). In contrast, average increments in ADSA were highest for combustion sources (as high as 3.2×103μm2cm-3 for meat grilling without exhaust ventilation) and lowest for electric appliances (20-90μm2cm-3). The health relevance of such particles is associated to their ability to penetrate cellular structures and elicit inflammatory effects mediated through oxidative stress in a way dependent on their surface area. The highest VOC concentrations were measured (PID probe) for cigarette smoke (8ppm) and spray air freshener (10ppm). The highest PM mass concentration (PM1) was measured for citronella candle burning (as high as 7.6mgm-3).

Accuracy of transcranial ultrasound in the detection of mild white matter lesions in newborns

Cranial Ultrasound (cUS) may not be sensitive enough to detect subtle white matter (WM) injuries. Our study compared serial cUS with MRI at term equivalent age (TEA) to determine if it is possible to identify an ultrasound representation of subtle diffuse WM injuries such as punctate lesions (PWMLs) and diffuse excessive high signal intensity (DEHSI). Fifty-six very preterm infants were scanned sequentially from birth to TEA, an MRI was performed at TEA. Each echodensity found on cUS was classified as absent, transient (≤7 days), or prolonged (>7 days). A transient periventricular echodensity was detected in seven infants (12.5%), and a prolonged echodensity in 15 (26.8%). MRI examinations were performed in all 56 infants. No altered signal intensity was found in 18 infants (32.1%). DEHSI was detected in 14 infants (25%), and PWMLs were detected in eight babies (14.3%). Both abnormalities were found in 16 infants (28.6%). The positive predictive values of the prolonged echodensity for DEHSI and PWMLs were 86.7% and 46.7% respectively. However, a significant statistical correspondence (p=0.002, Odds Ratio 11.9) was found comparing DEHSI with cUS abnormal echodensities. Serial cUS during the neonatal period in preterm infants is essential and cannot be replaced with MRI at TEA. MRI seems to be more reliable in detecting mild or moderate WM abnormalities. However, serial cUS performed by an experienced neonatologist can provide valuable information on early WM changes such as prolonged echodensities that could potentially lead to a diffuse injury.

Legionella control in the water system of antiquated hospital buildings by shock and continuous hyperchlorination: 5 years experience

BackgroundTo control the presence of Legionella in an old hospital water system, an integrated strategy of water disinfection-filtration was implemented in the university hospital Umberto I in Rome.MethodsDue to antiquated buildings, hospital water system design and hospital extension (38 buildings), shock hyperchlorination (sodium hypochlorite, 20–50 ppm of free chlorine at distal points for 1–2 h) followed by continuous hyperchlorination (0.5-1.0 mg/L at distal points) were adopted, and microbiological and chemical monitoring of the water supply was carried out in the university hospital (December 2006-December 2011).ResultsOverall, 1308 samples of cold <20°C (44.5%), mixed ≥20°C ≤ 45°C (37.7%) and hot >45°C (17.8%) water were collected, determining residual free chlorine (0.43 ± 0.44 mg/L), pH (7.43 ± 0.29) and trihalomethanes (8.97 ± 18.56 μg/L). Legionella was isolated in 102 (9.8%) out of 1.041 water samples without filters (L. pneumophila sg 1 17.6%, L. pneumophila sg 2–14 28.4%, L. non pneumophila 53.9%), and in none of the 267 samples with filters. Legionella was recovered in 23 buildings out of 38 and 29 samples (28.4%) exceeded 103 cfu/L. When considering the disinfection treatment Legionella was isolated: before shock hyperchlorination (21.1%), 15 days after shock hyperchlorination (7.8%), 30 days after shock hyperchlorination (3.5%), during continuous hyperchlorination (5.5%) and without continuous hyperchlorination (27.3%). Continuous hyperchlorination following the shock treatment achieved >70% reduction of positive samples, whereas no continuous hyperchlorination after shock treatment was more frequently associated to Legionella isolation (OR 6.41; 95% CI 3.10–13.26; p <0.001). Independent risk factors for Legionella isolation were: residual free chlorine <0.5 mg/L (OR 13.0; 95% CI 1.37 – 123.2; p <0.03), water T° ≥20°C ≤ 45°C (OR 12.0; 95% CI 1.28 – 111.48; p <0.03) and no continuous hyperchlorination after shock treatment (OR 10.3; 95% CI 1.06 – 100.05; p <0.05).ConclusionsShock and continuous hyperchlorination achieved significant Legionella reduction, but effective chlorine levels (>0.5 < 1.0 mg/L) deteriorated water quality (organoleptic and chemical). However, shock and continuous hyperchlorination remains a valid-term option in old buildings with no water system rational design, managing problems due to hospital extension and absence of a proper hot water recirculation system.

Pedestrians in Traffic Environments: Ultrafine Particle Respiratory Doses

Particulate matter has recently received more attention than other pollutants. PM10 and PM2.5 have been primarily monitored, whereas scientists are focusing their studies on finer granulometric sizes due both to their high number concentration and their high penetration efficiency into the respiratory system. The purpose of this study is to investigate the population exposure to UltraFine Particles (UFP, submicrons in general) in outdoor environments. The particle number doses deposited into the respiratory system have been compared between healthy individuals and persons affected by Chronic Obstructive Pulmonary Disease (COPD). Measurements were performed by means of Dust Track and Nanoscan analyzers. Forty minute walking trails through areas with different traffic densities in downtown Rome have been considered. Furthermore, particle respiratory doses have been estimated for persons waiting at a bus stop, near a traffic light, or along a high-traffic road, as currently occurs in a big city. Large differences have been observed between workdays and weekdays: on workdays, UFP number concentrations are much higher due to the strong contribution of vehicular exhausts. COPD-affected individuals receive greater doses than healthy individuals due to their higher respiratory rate.