A methodology to evaluate the optimal insulation thickness for heating and cooling needs in different climatic zones for buildings made of reinforced concrete with cavity walls.

The study aims to define a methodology to evaluate the optimal insulation thickness with reference to the annual energy balance, including both heating and cooling seasons, for different climatic zones, based on three real case studies. The reduction of the heating needs due to the insulation of walls in places with cold climates is a consolidated concept. However, the effects of a high level of insulation of the envelope on the cooling needs has not yet been deeply analysed. The heating and cooling needs have been computed according to UNI/TS 11300 Italian standard by means of a commercial numerical model, varying the sizes of the buildings, the climatic zone, and the level of insulation. All the simulations concern buildings made of reinforced concrete frames with cavity walls, because of their wide diffusion as typical building technology of post war constructions. The work highlights the negative impact of the coating on the cooling needs, especially in the climatic zones with lower degree days. In almost all the climatic zones, the cooling need decreases its peaks during the hottest months (e.g., July or August), while the monthly load increases in the mild months (e.g., May, September) due to the additional thermal load which is no longer dispersed by means of the envelope. In conclusion, a range of optimal thicknesses for insulation for the different Italian climatic zones has been identified based on the total energy need of the building (cooling and heating).

Correction to: Vilnius Declaration on chronic respiratory diseases: multisectoral care pathways embedding guided self-management, mHealth and air pollution in chronic respiratory diseases.

An amendment to this paper has been published and can be accessed via the original article.

Vilnius Declaration on chronic respiratory diseases: multisectoral care pathways embedding guided self-management, mHealth and air pollution in chronic respiratory diseases.

BACKGROUND: Over 1 billion people suffer from chronic respiratory diseases such as asthma, COPD, rhinitis and rhinosinusitis. They cause an enormous burden and are considered as major non-communicable diseases. Many patients are still uncontrolled and the cost of inaction is unacceptable. A meeting was held in Vilnius, Lithuania (March 23, 2018) under the patronage of the Ministry of Health and several scientific societies to propose multisectoral care pathways embedding guided self-management, mHealth and air pollution in selected chronic respiratory diseases (rhinitis, chronic rhinosinusitis, asthma and COPD). The meeting resulted in the Vilnius Declaration that was developed by the participants of the EU Summit on chronic respiratory diseases under the leadership of Euforea. CONCLUSION: The Vilnius Declaration represents an important step for the fight against air pollution in chronic respiratory diseases globally and has a clear strategic relevance with regard to the EU Health Strategy as it will bring added value to the existing public health knowledge.

[Chromomycosis by Rhinocladiella aquaspera: The first case in Venezuela.]. / Cromomicosis por Rhinocladiella aquaspersa: descripción del primer caso en Venezuela.

A case of chromomycosis induced by Rhinocladiella aquaspersa is decribed in Falcon State, which is considered as the first case in Venezuela, and the fifth one in the whole world of this species of Rhinocladiella. The case was observed in a five year-old child from the south part of Falcon State. The child presented wounds of two years of duration, in his upper left limb. These wounds were characterized by queloide cicatrices, and contiguous nodules, with a scalyo-scab surface. The disease was diagnosed through direct observation of cells extracted from the wounds and cleared with potassium hydroxide at 10%. The identification of R. aquaspersa was made by 1) The isolation in culture, using Lactritmel, Sabouraud-agar and Sablac as culture media; and 2) By observation, in slide culture, of dissemination structures characterized by erect conidiophores which were either simple or branched. The thermo-tolerance test applied indicate an optimum development temperature of 28 degrees C. It was not possible to reproduce the illness in Balb/c mice. The patient showed an unsatisfactory response to Itraconazol medication and improvement to an external local application therapy. Up to the present time, 370 cases of chromomycosis have been studied in Falcon State, with 21 cases in children. The suggests the existence of a susceptibility to this kind of mycosis from childhood.

Safety evaluation of chronic fluconazole therapy. Fluconazole Pan-American Study Group.

The possible adverse effects of chronic, high-dose fluconazole therapy are detailed from analysis of a multicenter, dose-escalating study of the therapy of invasive mycoses. Ninety-three adult patients were studied, 48 of these received > or = 6 months therapy and 20 received > or = 1 year. Fifty-eight patients received > or = 300 mg/day, and 7 received > or = 600 mg/day. One patient received 1,997 g over 86 months. Twenty-seven percent experienced possible symptomatic side effects, which resulted in 2 patients discontinuing therapy, and 42% had asymptomatic laboratory abnormalities, none of which were progressive. Headache, hair loss and anorexia were the most common symptoms experienced (each by 3% of patients), and eosinophilia and aspartate aminotransferase increases were the most common laboratory findings (12 and 10%, respectively). Fluconazole appears well tolerated and safe in these doses and durations.

Kartagener's syndrome in a woman with a normal ciliary structure and an intracranial meningioma.

Kartagener's syndrome is usually associated with ciliary abnormalities. We describe a case of Kartagener's syndrome observed in a woman with an intracranial meningioma and a normal axonemal structure. This finding confirms that ultrastructural defects of bronchial cilia are not always present in Kartagener's syndrome.

[Isradipine versus diltiazem in the treatment of stable effort angina pectoris: ergometric evaluation in a crossover double-blind study]. / Isradipina versus diltiazem nella terapia della angina stabile da sforzo: valutazione ergometrica in crossover doppio cieco.

OBJECTIVES: To evaluate the effects of isradipine (ISR) and diltiazem (DIL) on exercise tolerance and ischemic ST depression in patients with stable effort angina. METHODS: Fourteen out-patients, 9 males and 5 females, aged 46-65 years (mean +/- SD = 57 +/- 8), with ischemic heart disease and reproducible ST-segment depression on two consecutive exercise stress tests in baseline conditions, underwent a study consisting of 4 periods: 1 and 3 placebo, 2 and 4 at random ISR (5 mg b.i.d.) and DIL (120 mg b.i.d.). At the end of each period a multistage treadmill exercise stress test (Bruce protocol) was performed. RESULTS: Both drugs significantly (p < 0.001) increased ischemia time (IT) (0.1 mV ST depression) as compared to placebo, from 438 +/- 132 s. to 620 +/- 164 s. (ISR) and 583 +/- 147 s. (DIL) without statistical difference between two drugs (p = 0.2), and significantly reduced (p < 0.002) the maximal ST depression, from -0.20 +/- 0.11 mV to -0.07 +/- 0.07 mV (ISR) and -0.09 +/- 0.11 mV (DIL). At the IT, systolic blood pressure increased (p = 0.02), from 180 +/- 19 mm Hg to 187 +/- 15 mm Hg (ISR) and 191 +/- 15 mm Hg (DIL); similarly, heart rate increased from 133 +/- 24 bpm to 144 +/- 18 bpm (ISR: p = 0.002) and 140 +/- 17 bpm (DIL: p = NS). CONCLUSIONS: ISR and DIL, at the above dosage have showed an important and significant anti-ischemic effect (IT = +41.5% during ISR and +33.1% during DIL).

[An ergometric cross-over evaluation of the anti-ischemic efficacy of amlodipine and gallopamil in stable angina of effort]. / Valutazione ergometrica in cross-over dell'efficacia antischemica dell'amlodipina e del gallopamil nell'angina stabile da sforzo.

In the setting of stable effort angina a single-blind, randomized, cross-over study to evaluate the effects of gallopamil (GAL) and amlodipine (AML) on exercise tolerance and ischemic ST depression was conducted. Fifteen outpatients, 12 males and 3 females, aged 40-65 years (57 +/- 9), with documented coronary atherosclerosis and reproducible ST-segment depression on 2 consecutive baseline exercise stress tests, completed the study, which consisted of 4 periods: 1 and 3 placebo, 2 and 4 at random GAL (50 mg tid) and AML (10 mg/daily). At the end of each period a multistage treadmill exercise stress test (Bruce protocol) was performed. Both drugs significantly (p = 0.0001) increased the ischemia time (IT) (0.1 mV ST depression) as compared to placebo, from 416 +/- 165 s to 635 +/- 161 s (GAL) and 607 +/- 152 s (AML) with significant difference (p = 0.2) between the 2 drugs, and reduced significantly (p = 0.001) the maximal ST depression from -0.25 +/- 0.09 mV to -0.11 +/- 0.08 mV (GAL) and -0.12 +/- 0.09 mV (AML). At the IT, the systolic blood pressure increased from 178 +/- 23 mmHg to 185 +/- 20 mmHg (GAL) and remained unchanged during AML treatment (178 +/- 15 mmHg); similarly, the heart rate increased from 126 +/- 22 b/min to 139 +/- 21 b/min (GAL) and 138 +/- 19 b/min (AML). In conclusion, both GAL and AML showed a good anti-ischemic effect (IT = +52.6% during GAL and +45.9% during AML), even if GAL proved to be significantly more effective than AML.

A Pan-American 5-year study of fluconazole therapy for deep mycoses in the immunocompetent host. Pan-American Study Group.

Eighty-eight immunocompetent patients with deep mycoses from eight countries were evaluated with the same protocol for efficacy of fluconazole monotherapy. Entry doses were raised from 100 to 400 mg as safety was shown in initial cohorts, and dosages up to 2,400 mg daily and durations up to 44 months were studied. Results were very similar in different countries. Twenty-seven of 28 evaluable patients with paracoccidioidomycosis, 13 of 19 with sporotrichosis, 14 of 16 with coccidioidomycosis, and eight of eight with histoplasmosis demonstrated objective responses to therapy, as did one patient each with zygomycosis and alternariosis. For these patients, relapses have been unusual thus far. In contrast, one patient with chromoblastomycosis responded but relapsed, and six did not respond; one patient with mycetoma responded but relapsed, and two did not respond. The drug was well tolerated by patients, including six who received intravenous therapy. In vitro susceptibility tests suggested that clinical response was correlated with susceptibility but that resistance did not preclude clinical response. Fluconazole therapy appears efficacious for several deep mycoses; dosages of greater than 200 mg daily may be needed for some diseases. The further evaluation of fluconazole for these entities is warranted.

Tinea versicolor: epidemiologic, clinical, and therapeutic aspects.

Age of the patient, climate, season, and local environmental factors influence the onset and course of tinea versicolor (pityriasis versicolor). A number of effective topical therapies are available. In addition, a single dose of 400 mg of oral ketoconazole eliminates the disease and can be used prophylactically in some cases to prevent recurrence.

Antiarrhythmic short-term protective magnesium treatment in ischemic dilated cardiomyopathy.

The efficacy of magnesium sulfate (MgSO4) infusion in the treatment of ventricular arrhythmias was evaluated in 10 normomagnesemic patients: seven men and three women, aged 56-78 years (mean +/- SD, 63.8 +/- 9.3). All of the patients had ischemic dilated cardiomyopathy (IDC) and severe ventricular arrhythmias: multiform ventricular premature contractions (VPCs), couplets, runs of ventricular tachycardia (VT), and R-on-T phenomenon. Four had evidence of old myocardial infarction (MI), four had chronic ischemic cardiomyopathy, and two had effort angina pectoris. Dilated cardiomyopathy was diagnosed by chest X-ray (cardiothoracic ratio greater than 0.5) and echocardiogram (end-diastolic left-ventricular diameter greater than 56 mm). All of the patients underwent two successive 24-hr Holter monitoring at the time of admission and after 3, 5, and 10 days from the beginning of therapy. Ventricular arrhythmias were classified according to modified Lown criteria. Renal function was normal. Magnesium sulfate in 0.9% sodium chloride was given by slow infusions (50 mg/min/60 min) twice daily for 7 days. They were antiarrhythmic in all of the patients: VPCs and couplets mean values decreased from 7971 +/- 2612 to 321 +/- 141 (p less than 0.001) and from 405 +/- 113 to 7 +/- 4 (p less than 0.001), respectively; VT runs (33.8 +/- 5.8) disappeared by the fifth day of treatment. Both the heart rate and the QTc interval remained unchanged from baseline values. The slow magnesium infusion did not notably raise serum Mg when evaluated immediately after stopping the infusion, as compared with baseline values.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cutis "trunci variata." A new genetic dermatosis]. / Cutis "trunci variata". Nueva genodermatosis.

A maculo-hypochromic condition is not rarely seen in brown-skinned adolescents and young adults, that may spread over the skin of the trunk, specially the lumbar, sacral and epigastric regions assuming a considerable psychologic important. It is generally confused with pityriasis versicolor or its hypochromic sequelae. The histologic and genetic study of the condition remains undone. It is provisionally considered among genodermatoses and the name cutis trunci variata is being proposed for it.

[Experience with homemade substrates for mycology]. / Experiencia con terrenos caseros para micología.

The meaning of the words "home-made", "medium" and "soil" is defined. The formulae are given and the manner for preparing lactritmel, lacmel and tritmel is described. The same for horse and cow dung agar soils is done. The lactritmel (20 fold diluted in water) is recommended for the specific diagnosis of Candida albicans in its nascent culture. The first results are communicated, as obtained by slide culturing fungi on banana (Musa paradisiaca) fruit pulp without previous sterilization. The amusing aspect of fungi-culturing is emphasized.

A clinical trial of itraconazole in the treatment of deep mycoses and leishmaniasis.

Itraconazole was administered orally to two patients with sporotrichosis, 10 patients with paracoccidioidomycosis, three with mycetomas (due to Madurella grisea, Streptomyces madurae, and Pseudochaetosphaeronema larense, respectively), nine with chromomycosis due to Cladosporium carrionii, five with chromomycosis due to Fonsecaea pedrosoi and five with leishmaniasis (including one with the nodular disseminated form). The clinical and laboratory tests showed excellent tolerance to the drug with a total absence of adverse reactions. Satisfactory results were achieved against paracoccidioidomycosis, sporotrichosis, and chromomycosis due to C. carrionii (apparent cure was achieved in a short time). Encouraging improvement was noted in the treatment of mycetoma due to M. grisea. Among the five cases of leishmaniasis, a complete clearing was achieved in one and an encouraging improvement in two, including the one with the nodular disseminated form. Two patients with F. pedrosoi infection were apparently cured after the addition of thermotherapy and flucytosine, respectively, to the treatment regimen.

Terapia de la paracoccidioidomicosis: valor actual de los antiguos tratamientos / Therapy of the paracoccidioidomycosis: actual value of the treatment old

Para establecer la debida perspectiva, he tratado de evocar las condiciones de la era pre-terapéutica, citando autores clásicos, que describen el resignado dolor de los pacientes y la humillada impotencia de los médicos. La época de los tratamientos antiguos fue de esperanza parcialmente frustada. Considero antiguos los tratamientos de la paracoccidioidomicosis anteriores a los imidazólicos de uso oral. Antiguos y obsoletos. De ellos nos queda el valor de la experiencia que nos permitieron adquirir. Creo que fue posible en teoría erradicar la infección de todos los pacientes mediante la administración de sulfas en dosis correctas durante dos o tres años, pero en la práctica, no se logró la suficiente claridad de criterios, ni hubo, ni hay manera de acompañar a los pacientes durante ese tiempo. Las sulfas nos enseñaron que la paracoccidioidomicosis debe tratarse ininterrumpidamente por largo tiempo. Estimo que la anfotericina permitió prolongar la vida de la mayoría de los pacientes y erradicar la infección de la mitad de los pacientes tratados correctamente. Por el alto costo y la gran atención que requiere su administración, nunca ha sido una opción liberadora en paracoccidioidomicosis. La anfotericina nos enseñó que la calidad del médico es fundamental para la conducción exitosa del tratamiento. Finalmente, en muchos países del área endémica, persiste la negligencia del estado para con la asistencia a los pacientes después de su salida del hospital, igual que en los tiempos aciagos de los tratamientos antiguos. De todos modos, considero un evento feliz el haber superado los tratamientos antiguos

Terapia de la paracoccidioidomicosis: valor actual de los antiguos tratamientos / Therapy of the paracoccidioidomycosis: actual value of the treatment old

Para establecer la debida perspectiva, he tratado de evocar las condiciones de la era pre-terapéutica, citando autores clásicos, que describen el resignado dolor de los pacientes y la humillada impotencia de los médicos. La época de los tratamientos antiguos fue de esperanza parcialmente frustada. Considero antiguos los tratamientos de la paracoccidioidomicosis anteriores a los imidazólicos de uso oral. Antiguos y obsoletos. De ellos nos queda el valor de la experiencia que nos permitieron adquirir. Creo que fue posible en teoría erradicar la infección de todos los pacientes mediante la administración de sulfas en dosis correctas durante dos o tres años, pero en la práctica, no se logró la suficiente claridad de criterios, ni hubo, ni hay manera de acompañar a los pacientes durante ese tiempo. Las sulfas nos enseñaron que la paracoccidioidomicosis debe tratarse ininterrumpidamente por largo tiempo. Estimo que la anfotericina permitió prolongar la vida de la mayoría de los pacientes y erradicar la infección de la mitad de los pacientes tratados correctamente. Por el alto costo y la gran atención que requiere su administración, nunca ha sido una opción liberadora en paracoccidioidomicosis. La anfotericina nos enseñó que la calidad del médico es fundamental para la conducción exitosa del tratamiento. Finalmente, en muchos países del área endémica, persiste la negligencia del estado para con la asistencia a los pacientes después de su salida del hospital, igual que en los tiempos aciagos de los tratamientos antiguos. De todos modos, considero un evento feliz el haber superado los tratamientos antiguos (AU)