Diagnosis of Tuberculosis in a Case of Chronic Urticaria following Omalizumab Therapy.

In Italy, tuberculosis (TB) incidence in the last decade has remained constant at under 10 cases/100,000 inhabitants. In the Philippines, TB annual incidence is greater than 500 cases/100,000 inhabitants. Omalizumab is a humanized anti-IgE monoclonal antibody approved for the treatment of chronic spontaneous urticaria. We report the case of a 32-year-old Filipino woman who suffered from chronic urticaria, treated with topic steroids since June 2022 and systemic steroids for 2 weeks. In November 2022, she started omalizumab therapy at a monthly dose of 300 mg; she was not screened for TB infection. In the same month, a left laterocervical lymphadenopathy arose, which worsened in February 2023 (diameter: 3 cm). The patient recovered in April 2023 in INMI "Lazzaro Spallanzani" in Rome for suspected TB. Chest CT showed a "tree in bud" pattern at the upper-right pulmonary lobe. The patient tested positive for lymph node biopsy molecular tuberculosis. The patient started standard antituberculosis therapy. She discontinued omalizumab. To our knowledge, this is the second diagnosed TB case during omalizumab treatment, which suggests that attention should be paid to the known risk of TB during biotechnological treatments. Even if current guidelines do not recommend screening for TB before starting anti-IgE therapy, further data should be sought to assess the relationship between omalizumab treatment and active TB. Our experience suggests that screening for TB should be carried out in patients from highly tuberculosis-endemic countries before starting omalizumab therapy.

Disability in moderate chronic obstructive pulmonary disease: prevalence, burden and assessment - results from a real-life study.

BACKGROUND: The role of disability and its association with patient-reported outcomes in the nonsevere forms of chronic obstructive pulmonary disease (COPD) has never been explored. OBJECTIVES: The aim of this study was to assess, in a cross-sectional real-life study, the prevalence and degree of disability in moderate COPD patients and to assess its association with health status, illness perception, risk of death and well-being. METHODS: Moderate COPD outpatients attending scheduled visits were involved in a quantitative research program using a questionnaire-based data collection method. RESULTS: Out of 694 patients, 17.4% were classified as disabled and 47.6% reported the loss of at least one relevant function of daily living. Disabled patients did not differ from nondisabled patients in terms of working status (p = 0.06), smoking habits (p = 0.134) and ongoing treatment (p = 0.823); however, the former showed a significantly higher disease burden as measured by illness perception, health status and well-being. The stepwise regression analysis showed that the modified Medical Research Council (mMRC) score was the most relevant factor related to COPD disability (F = 38.248; p = 0.001). Patient stratification was possible according to the forced expiratory volume in 1 s (FEV1) value and an mMRC score ≥2, which identified disabled patients, whereas the mMRC values were differently associated with the risk of disability. CONCLUSION: A significant proportion of individuals with moderate COPD reported a limitation of daily life functions, with dyspnea being the most relevant factor inducing disability. Adding the evaluation of patient-reported outcomes to lung function assessment could facilitate the identification of disabled patients.

[The Latin-American Consensus on Chronic Constipation]. / Consenso Latinoamericano de Estreñimiento Crónico.

The Latin-American Consensus on Chronic Constipation aimed to establish guidelines to improve the identification, diagnosis and treatment of this disorder in the region. Two coordinators and an honorary coordinator established the process and the topics to be discussed, based on a systematic review of the literature published in the previous 10 years, since 1995. Seventeen members participated with the support of their local gastroenterology societies. The members reviewed the different subjects based on the levels of evidence and grades of recommendation; the topics were then discussed in a plenary session. A written report was drafted and the coordinators prepared the final declarations to be submitted to a vote by all the members in October 2006. The consensus concluded that chronic constipation has an estimated prevalence of 5-21% in the region, with a female-to-male ratio of 3:1. Among individuals with constipation, 75% use some type of medication, with more than 50% using home remedies. A diagnosis based on Rome Criteria was recommended and diagnostic testing only in persons older than 50 years or with alarm symptoms. The use of barium enema as an initial investigation was recommended only in countries with a high prevalence of idiopathic megacolon or Chagas' disease. Recommendations on treatment included an increase in dietary fiber of up to 25-30 g/day (grade C). No evidence was found to recommend measures such as exercise, increased water intake, or frequent visits to the toilet. Fiber supplements such as Psyllium received a grade B and pharmacological treatments such as tegaserod and polyethylene glycol, both grade A. There was insufficient evidence to recommend lactulose, but the consensus did not disadvise its use when necessary. Complementary investigations such as colonic transit followed by anorectal manometry and defecography were only recommended to rule out colonic inertia and/or obstructive defecation in patients not responding to treatment. Biofeedback was recommended (grade B) for those with pelvic dyssynergia.

Consenso Latinoamericano de Estreñimiento Crónico / The Latin-American Consensus on Chronic Constipation aimed to establish guidelines to improve the identification, diagnosis and treatment of this disorder in the region. Two coordinators and an honorary coordinator established the process and the topics to be discussed, based on a systematic review

El Consenso Latinoamericano de Estreñimiento Crónico se realizó con el objeto de proveer guías para mejorar la identificación, el diagnóstico y el tratamiento de este trastorno en la región. Dos coordinadores, y uno honorario, establecieron las líneas de consenso, basado en una revisión sistemática de la literatura médica de los últimos 10 años a partir de 1995. Participaron 17 miembros con el aval de sus respectivas sociedades locales de gastroenterología. Éstos revisaron y presentaron los temas con sus niveles de evidencia y grados de recomendación para discutirlos en una reunión plenaria. Tras un informe final de los miembros, los coordinadores prepararon las declaraciones finales para someterlas a votación en octubre de 2006. El consenso concluyó que el estreñimiento crónico tiene una prevalencia estimada del 5-21% en la región, con una relación mujer:varón de 3:1. El 75% de los sujetos que lo presenta utiliza algún tipo de medicamentos y más del 50% usa medicamentos caseros. Se recomendó un diagnóstico basado en los Criterios de Roma y los estudios diagnósticos sólo en pacientes mayores de 50 años o con algún signo de alarma. El uso de enema de colon se recomendó como investigación inicial en países con elevada frecuencia de megacolon idiopático y/o enfermedad de Chagas. En cuanto al tratamiento, se recomendó incrementar la fibra en la dieta a 25-30 g/día (grado C) y no se encontraron evidencias para ciertas medidas, como el ejercicio, el aumento de la ingesta de agua o las visitas programadas al excusado. El Psyllium recibió recomendación grado B y tratamientos farmacológicos, como tegaserod y polietilenglicol grado A. No se encontraron suficientes evidencias para recomendar la administración de lactulosa, pero no se desaprobó su uso cuando fuera necesario. Los estudios complementarios, como el tránsito colónico seguido de manometría anorrectal y defecografía, sólo se recomendaron para descartar la inercia colónica y/o la obstrucción funcional en pacientes que no respondieran al tratamiento. La biorretroalimentación se recomendó (grado B) en la disinergia del suelo pélvico

The Latin-American Consensus on Chronic Constipation aimed to establish guidelines to improve the identification, diagnosis and treatment of this disorder in the region. Two coordinators and an honorary coordinator established the process and the topics to be discussed, based on a systematic review of the literature published in the previous 10 years, since 1995. Seventeen members participated with the support of their local gastroenterology societies. The members reviewed the different subjects based on the levels of evidence and grades of recommendation; the topics were then discussed in a plenary session. A written report was drafted and the coordinators prepared the final declarations to be submitted to a vote by all the members in October 2006. The consensus concluded that chronic constipation has an estimated prevalence of 5-21% in the region, with a female-to-male ratio of 3:1. Among individuals with constipation, 75% use some type of medication, with more than 50% using home remedies. A diagnosis based on Rome Criteria was recommended and diagnostic testing only in persons older than 50 years or with alarm symptoms. The use of barium enema as an initial investigation was recommended only in countries with a high prevalence of idiopathic megacolon or Chagas' disease. Recommendations on treatment included an increase in dietary fiber of up to 25-30 g/day (grade C). No evidence was found to recommend measures such as exercise, increased water intake, or frequent visits to the toilet. Fiber supplements such as Psyllium received a grade B and pharmacological treatments such as tegaserod and polyethylene glycol, both grade A. There was insufficient evidence to recommend lactulose, but the consensus did not disadvise its use when necessary. Complementary investigations such as colonic transit followed by anorectal manometry and defecography were only recommended to rule out colonic inertia and/or obstructive defecation in patients not responding to treatment. Biofeedback was recommended (grade B) for those with pelvic dyssynergia (AU)

Clara cell 16 protein in COPD sputum: a marker of small airways damage?

RATIONALE: The development of chronic obstructive pulmonary disease (COPD) in smokers and their susceptibility to infections is not fully understood. Recent evidences suggest that Clara cells play a part in host defense, immunomodulatory response and airways remodelling through the production of specific factors such as Clara cell 16 (CC-16). This protein has never been related to patients' lung function tests, blood gases parameters and diseases severity. OBJECTIVES: To evaluate a possible correlation between CC-16 expression in sputum, measured by a new methodological approach, and the degree of severity in patients with moderate and severe COPD. We also analyzed possible correlations between CC-16 and cytological sputum population, arterial blood gases and lung function. MAIN FINDINGS: We analyzed 20 patients, mean age 72.95, classified on the basis of the global initiative for chronic obstructive lung disease guidelines (GOLD 2006). The samples were processed for cytological analysis and CC-16 levels were assessed by Western blot. We found lower levels of CC-16 in severe COPD compared to moderate ones (p<0.027). No statistically significant differences were found between CC-16 expression and sputum cellularity (except for macrophages), arterial blood gases, and spirometric parameters. Multiple linear regression analysis of CC-16 versus functional and cytological parameters showed no significance. CONCLUSIONS: We found a significantly different expression of CC-16 in COPD patients, according to their stage of severity, as defined by the GOLD 2006 guidelines. Considering CC-16 properties in innate immunity, a possible link between protein expression, innate immune system, and COPD infectious exacerbations may be hypothesized but further investigation are needed.

[TREATMENT OF PEPTIC ULCER] / Tratamiento de la Ulcera Péptica.

Peptic ulcer disease has been the reason for extensive studies throughout the 20th Century. During the first 75 years, investigation and study of the production of acid and in which cases it leads to the formation of ulcers were carried out. The last 25 years have been of major importance due to the finding of powerful suppressants of acid formation. At first, the Histamine H2-antagonist, then the blockers of the proton bomb; and also the Helicobacter pylori finding, as an important factor in peptic ulcer disease. During these last years, studies report about how the Helicobacter pylori works in the stomach of patients who are liable to produce ulcers. Now, we also know more about the action of the antiulcerative drugs, and how to use them in the best way. Lately, the recurrence of peptic ulcer and bacterial resistance of the Helicobacter pylori are concepts that are being studied most profoundly.

Tratamiento de la ulcera péptica / Treatment of peptic ulcer

La enfermedad péptica ha sido motivo de extensos estudios durante todo el siglo XX. Los primeros 75 años han sido de investigación y conocimiento de la forma como el ácido es producido y en que casos este ácido induce la formación de úlceras. Los últimos 25 años han sido importantes por el descubrimiento de supresores potentes de la formación de ácido, primero los antagonistas H2 histamina y luego los bloqueadores de la bomba de protones; y por el descubrimiento del helicobacterpylori como factor importante en la enfermedad ulcerosa péptica. Estos últimos años estudios reportan como el H.p actúa en el estomago de pacientes suceptibles para producir úlceras. Conocemos asimismo mas sobre la acción de los medicamentos antiulcerosos y como usarlos de la mejor forma. La recurrencia de la úlcera péptica y la resistencia bacteriana del H.p son los conceptos que están estudiando con mas intensidad últimamente.