Thoracic ultrasound combined with low-dose computed tomography may represent useful screening strategy in highly exposed population in the industrial city of Taranto (Italy).

Objectives: We validated a screening protocol in which thoracic ultrasound (TUS) acts as a first-line complementary imaging technique in selecting patients which may deserve a second-line low-dose high resolution computed tomography (HRCT) scan among a population of asymptomatic high-risk subjects for interstitial lung abnormalities (ILA) and lung cancer. Due to heavy environmental pollution burden, the district Tamburi of Taranto has been chosen as "case study" for this purpose. Methods: From July 2018 to October 2020, 677 patients aged between 45 and 65 year and who had been living in the Tamburi district of Taranto for at least 10 years were included in the study. After demographic, clinical and risk factor exposition data were collected, each participant underwent a complete TUS examination. These subjects were then asked to know if they agreed to perform a second-level examination by low-dose HRCT scan. Results: On a total of 167 subjects (24.7%) who agreed to undergo a second-level HRCT, 85 patients (50.9%) actually showed pleuro-pulmonary abnormalities. Interstitial abnormalities were detected in a total of 36 patients on HRCT scan. In particular, 34 participants presented subpleural ILAs, that were classified in the fibrotic subtype in 7 cases. The remaining 2 patients showed non-subpleural interstitial abnormalities. Subpleural nodules were observed in 46 patients. TUS showed an overall diagnostic accuracy of 88.6% in detecting pleuro-pulmonary abnormalities in comparison with HRCT scan, with a sensitivity of 95.3%, a specificity of 81.7%, a positive predictive value of 84.4% and a negative predictive value of 94.4%. The matched evaluation of specific pulmonary abnormalities on HRTC scan (i.e., interstitial abnormalities or pulmonary nodules) with determinate sonographic findings revealed a reduction in both TUS sensibility and specificity. Focusing TUS evaluation on the assessment of interstitial abnormalities, a thickened pleural line showed a sensitivity of 63.9% and a specificity of 69.5%, hypoechoic striae showed a sensitivity of 38.9% and a specificity of 90.1% and subpleural nodules showed a sensitivity of 58.3% and a specificity of 77.1%. Regarding to the assessment of subpleural nodules, TUS showed a sensitivity of 60.9% and a specificity of 81.0%. However, the combined employment of TUS examination and HRCT scans allowed to identify 34 patients with early subpleural ILA and to detect three suspicious pulmonary nodules (of which two were intraparenchymal and one was a large subpleural mass), which revealed to be lung cancers on further investigations. Conclusion: A first-line TUS examination might aid the identification of subjects highly exposed to environmental pollution, who could benefit of a second-line low-dose HRCT scan to find early interstitial lung diseases as well as lung cancer. Protocol registration code: PLEURO-SCREENING-V1.0_15 Feb, 17.

Effectiveness of Benralizumab in Improving the Quality of Life of Severe Eosinophilic Asthmatic Patients: Our Real-Life Experience.

Background: Severe eosinophilic asthma decreases lung function and causes worsen symptoms, often forcing recurrent maintenance corticosteroid use. The aim of our real-life study was to evaluate the effectiveness of an add-on treatment with benralizumab in patients with severe eosinophilic asthma, paying particular attention to the impact on their quality of life (QoL). Materials and methods: In this prospective study, 10 outpatients with severe eosinophilic asthma were added-on with benralizumab and followed-up in our severe asthma clinic after 12 and 24 weeks. At each patient visit, pre-bronchodilator FEV1 and inflammatory markers were recorded. Variations in asthma symptoms control and QoL perception was assessed by validated questionnaires. Results: All the subjects experienced a marked reduction of nocturnal and diurnal symptoms over time and were able to stop using OCS, as documented by the improvement in Asthma control test (ACT) and Asthma Control Questionnaire score. Similarly, we recorded a statistically significant increase in patient's QoL perception in EQ-VAS, EQ-5D-3L and Asthma Quality of Life Questionnaire (AQLQ) assessment (p < 0.05). Simultaneously we recorded a significant reduction in eosinophilic inflammation, an improvement in pre-bronchodilator FEV1. These results appear to be in line with those already obtained in the previous randomized controlled trials (RCTs). Conclusion: Our 24-weeks real life experience supports the effectiveness of an add-on treatment with benralizumab in reducing eosinophilic inflammation and OCS-use, increasing lung function and improving control of nocturnal and diurnal symptoms, as well as restoring severe asthma patients to a better QoL.

A survey of fungal microbiota in airways of healthy volunteer subjects from Puglia (Apulia), Italy.

BACKGROUND: The human respiratory tract represents the major portal of entry for numerous microorganisms, primarily those occurring as airborne particles such as viral and bacterial entities, or fungal spores. Microorganism characteristics coupled with the local host immune response will determine whether they will be cleared or adhere and colonize the airways leading to acute or chronic pulmonary disease. Like bacteria, fungi can cause severe lung diseases, but their infection rates are much lower. The lung microbiota is commonly sampled using relatively invasive bronchoscopic procedures. Exhaled breath condensate (EBC) collection offers a potentially less invasive alternative for lung microbiota sampling. This study tries to determine the composition of fungal communities in a cohort of healthy adult volunteer subjects from Puglia (Apulia), Italy. METHODS: Fungi diversity in 27 EBC samples collected from Italian adult volunteers was investigated using conventional microbiological culturing and DNA sequencing approach. RESULTS: Ten tested subjects (37,03%) turned out to present fungi in the EBC. We observed complex fungal communities, in which more than 10% of the isolated species are represented by Aspergillus sydowii (14,8%) and Cladosporium spp (11,11%). Three subjects that showed fungal presence in EBC have been diagnosed with a respiratory disease. CONCLUSIONS: We present a survey of an important scientific field in its early stages that is fungal contamination of airways of healthy subjects in a small geographic area. Furthermore, we interpreted our results to highlight the potential role of fungi in the context of respiratory diseases.

Alta prevalencia de obesidad en una poblacion laboral en España / High prevalence of obesity in a Spanish working population

Antecedentes y objetivo Describir la prevalencia de la obesidad y su evolucion reciente en una poblacion laboral en España. Material y (..) (AU)

Background and objectives To report the prevalence of obesity in a Spanish working population and its changes in recent years. Material and methods Data were collected from routine medical examinations performed on workers by a national mutual insurance society for occupational accidents and diseases (Ibermutuamur). A structured (..) (AU)

High prevalence of obesity in a Spanish working population.

BACKGROUND AND OBJECTIVES: To report the prevalence of obesity in a Spanish working population and its changes in recent years. MATERIAL AND METHODS: Data were collected from routine medical examinations performed on workers by a national mutual insurance society for occupational accidents and diseases (Ibermutuamur). A structured questionnaire was completed and physical examinations were performed. Overweight was defined as BMI ranging from 25 and 29.9, obesity as BMI of 30-39.9, and morbid obesity as BMI ≥ 40 kg/m(2). RESULTS: Data from 1,336,055 medical examinations performed from May 2004 to November 2007 were collected. Prevalence rates in the population examined in 2004 (n=230,684; 73% males; average age, 36.4 years) were: morbid obesity, 0.5% (0.6% males, 0.5% females); obesity, 14.5% (17.0% males, 7.7% females); overweight, 38.4% (44.8% males, 21.3% females). Prevalence rates of obesity and overweight were higher in blue-collar workers (16.4% and 40.5% respectively) as compared to white-collar workers (10.9% and 34.4% respectively). There was a progressive increase in prevalence of obesity during the 4-year study (2004-2007) in both males (17.0%, 17.6%, 17.9%, 18.2%) and females (7.6%, 8.0%, 8.4%, 8.7%). CONCLUSIONS: Prevalence of obesity and overweight in the Spanish working population is high, especially in male blue-collar workers, and is increasing. There is a need to promote early prevention programs and specific treatments for obesity.

Análisis de la tolerancia hemodinámica en pacientes en hemodiálisis medida por la hipotensión arterial / Analysis of haemodynamic tolerance in haemodialysis patients measured through hypotension

La hipotensión arterial sintomática es una de las complicaciones agudas más frecuente en la hemodiálisis. El objetivo de nuestro estudio es evaluar la eficacia de la administración pautada de una solución salina hipertónica, para prevenir los episodios de hipotensión arterial sintomática. Es un estudio que consta de dos fases de 15 sesiones cada una, se incluyeron a 15 pacientes, con edades comprendidas entre los 30 y los 85 años. En la fase A se siguieron los procedimientos habituales de la unidad y en la fase B se administró solución salina hipertónica al 20%, una ampolla (10ml) pauta dac/hora, en las fases iniciales y medias de las sesiones, evitando los últimos 30 ó 60 minutos. Se observó una disminución significativa entre la fase A y la fase B en el número medio de episodios de hipotensión intradiálisis, en el grado de malestar, en el dolor articular intra-diálisis y en el Na+ plasmático post-diálisis, así como en la infusión de volumen. No se observaron diferencias significativas en la sed y la ganancia de peso inter-diálisis, ni en el dolor articular post-diálisis. Los resultados sugieren que la administración de cloruro sódico hipertónico pautado en las fases iniciales y medias de las sesiones, tiene utilidad clínica en los pacientes con episodios previos de hipotensión sintomática durante la hemodiálisis (AU)

Symptomatic hypotension is one of the most frequent acute complications in hemodialysis. The aim of our study is to evaluate the efficacy of the controlled administration of a hypertonic saline solution in preventing episodes of symptomatic arterial hypotension. This is a study comprising two phases of 15 sessions each, which included 15 patients, with ages ranging from 30 to 85. In phase A, the habitual procedures of the unit were followed and in phase B a 20% hypertonic saline solution was administered at the controlled rate of one bottle (10ml) every hour, in the initial and middle phases of the sessions, avoiding the last 30 or 60 minutes. A significant reduction was observed between phase A and phase B in the average number of episodes of intradialytic hypotension, in the degree of malaise, in intradialytic joint pain and in post-dialysis plasma Na+, as well as in the volume infusion. No significant differences in inter-dialysis thirst and weight gain were observed, or in post-dialysis pain. The results suggest that the administration of controlled hypertonic sodium chloride in the initial and middle phases of the session has clinical usefulness in patients with prior episodes of symptomatic hypotension during haemodialysis (AU)

[First antiretroviral therapy regimen in HIV-infected patients. Durability and factors associated with therapy changes]. / Primera pauta de tratamiento antirretroviral en pacientes con infección por el virus de la inmunodeficiencia humana. Durabilidad y factores asociados a su modificación.

AIM: To analyze the durability of the first highly active antiretroviral therapy (HAART) regimen used in naïve HIV-infected patients and the factors leading to therapy changes. METHODS: Multicenter, retrospective study of naïve HIV-infected patients from 5 hospitals in Málaga (southeast Spain), who started HAART between January 1997 and December 2003. The main outcome measure was median time to the first change in the antiretroviral regimen. A descriptive analysis was performed and Kaplan-Meier curves were used to assess durability of the first HAART used. Independent factors associated with durability were evaluated with a Cox multiple regression model. RESULTS: A total of 603 patients started HAART, and 130 (21.6%) remained under the same treatment at the latest evaluation point. Median time on the same HAART was 17.5 months, and reached 24 months when cases of simplification or structured intermittent treatment interruption were excluded from the analysis. HAART had been interrupted in 36% by one-year of follow-up. Toxicity was the main cause of switching therapy (25%), followed by simplification (19%), and virologic failure (15%). Longer durability of HAART was observed in non-nucleoside reverse transcriptase inhibitor (NNRTI) regimens, (P < 0.046; HR, 1.58) and in those with less than 5 pills (P < 0.001; HR, 2.05). CONCLUSION: Median durability of the first HAART was almost one year and a half, and discontinuation was mainly due to toxicity. NNRTI regimens showed longer durability, which could be attributable to a lower pill burden, at least in part.

Primera pauta de tratamiento antirretroviral en pacientes con infección por el virus de la inmunodeficiencia humana. Durabilidad y factores asociados a su modificación / First antiretroviral therapy regimen in HIV-infected patients. Durability and factors associated with therapy changes

OBJETIVOS. Se evaluó la durabilidad de la primera pauta de tratamiento antirretroviral de gran actividad (TARGA) en pacientes sin tratamiento antirretroviral previo infectados por el virus de la inmunodeficiencia humana (VIH) y los factores asociados a su modificación. MÉTODOS. Estudio multicéntrico, retrospectivo, de pacientes con infección por el VIH que iniciaron su primer TARGA entre 1997 y 2003. La variable principal medida fue la durabilidad de la primera pauta de TARGA hasta su cambio. Se realizó estadística descriptiva, curvas de Kaplan-Meier para evaluar la durabilidad y se construyó un modelo de regresión múltiple de Cox para valorar los factores asociados a la durabilidad. RESULTADOS. Iniciaron su primer TARGA 603 pacientes y 130 (21,6%) lo mantuvieron hasta la visita final, con una mediana de duración de 17,5 meses. Un 36% de los pacientes interrumpió el tratamiento antes del año. Cuando se excluyeron las causas “no desfavorables”(simplificación/interrupción estructurada), la mediana de duración aumentó hasta los 2 años. La causa principal del cambio fue la toxicidad (25%), seguida de la simplificación(19%) y el fracaso virológico (15%). Se encontró una mayor durabilidad de las pautas con un inhibidor de la transcriptasa inversa no análogo de nucleósidos (ITINAN)(p < 0,046; hazard ratio [HR], 1,58) y de aquellas con menos de cinco comprimidos (p < 0,001; HR, 2,05).CONCLUSIÓN. La mediana de duración del primer TARGA fue algo menor de 1,5 años y la causa principal del cambio fue la toxicidad. Se constata una mayor durabilidad de las pautas con ITINAN que, al menos en parte, podría explicarse por su menor número de comprimidos (AU)

AIM. To analyze the durability of the first highly active antiretroviral therapy (HAART) regimen used in naïve HIV-infected patients and the factors leading to therapy changes. METHODS. Multicenter, retrospective study of naïve HIV-infected patients from 5 hospitals in Málaga(southeast Spain), who started HAART between January 1997 and December 2003. The main outcome measure was median time to the first change in the antiretroviral regimen. A descriptive analysis was performed and Kaplan-Meier curves were used to assess durability of the first HAART used. Independent factors associated with durability were evaluated with a Cox multiple regression model. RESULTS. A total of 603 patients started HAART, and130 (21.6%) remained under the same treatment at the latest evaluation point. Median time on the same HAART was 17.5 months, and reached 24 months when cases of simplification or structured intermittent treatment interruption were excluded from the analysis. HAART had been interrupted in 36% by one-year of follow-up. Toxicity was the main cause of switching therapy (25%), followed by simplification (19%), and virologic failure (15%). Longer durability of HAART was observed in non-nucleoside reverse transcriptase inhibitor (NNRTI) regimens, (P < 0.046; HR, 1.58) and in those with less than 5 pills (P < 0.001; HR, 2.05).CONCLUSION. Median durability of the first HAART was almost one year and a half, and discontinuation was mainly due to toxicity. NNRTI regimens showed longer durability, which could be attributable to a lower pill burden, at least in part (AU)