Radiation Recall Pneumonitis Anticipates Bilateral Immune-Induced Pneumonitis in Non-Small Cell Lung Cancer

Radiation recall pneumonitis (RRP) is a rare inflammatory reaction that occurs in previously irradiated fields, and it may be caused by various triggering agents. Immunotherapy has been reported to potentially be one of these triggers. However, precise mechanisms and specific treatments have not been explored yet due to a lack of data in this setting. Here, we report a case of a patient who received radiation therapy and immune checkpoint inhibitor therapy for non-small cell lung cancer. He developed first radiation recall pneumonitis and subsequently immune-checkpoint inhibitor-induced pneumonitis (IIP). After presenting the case, we discuss the currently available literature on RRP and the challenges of differential diagnosis between RRP, IIP, and other forms of pneumonitis. We believe that this case is of particular clinical value since it highlights the importance of including RRP in a differential diagnosis of lung consolidation during immunotherapy. Furthermore, it suggests that RRP might anticipate more extensive ICI-induced pneumonitis

Arm position as a source of error in blood pressure measurement

The present study was designed to assess the value of correct positioning of a patient's arm when measuring blood pressure (BP). A total of 181 subjects were examined, 141 hypertensives on treatment, 25 untreated hypertensives, 15 normotensives. All the subjects underwent three BP measurements after a 5-min resting period in supine position. Then two BP readings were recorded in standing position with the arm either positioned by the patient's side or supported passively at patient's heart level. Average systolic BP (SBP) in standing position were 144.6 +/- 20.2 mmHg with the arm at the side and 136.4 +/- 21.1 mmHg with the arm at the heart level (p less than 0.001); average diastolic pressures were 99.0 +/- 12.0 mmHg and 90.2 +/- 12.3 mmHg (p less than 0.001), respectively. A fall in SBP greater than or equal to 20 mmHg from the supine to the upright position was detected in 18.2% of cases when measurement was performed at heart level; such a reduction was inapparent in two-thirds of cases when the arm was placed at the patient's body side. Incorrect positioning of a patient's arm during BP measurements in standing position leads to overestimation of BP values and masks the presence of postural hypotension

Spesolimab in patients with flare of generalized pustular psoriasis: A multicentre case-series

Dear Editor,Generalized pustular psoriasis (GPP) is a rare, potentially life-threatening, chronic inf lammatory disease character-ized by acute f lares of pustular eruptions that can be accom-panied by systemic inf lammation. GPP can be associated with chronic plaque psoriasi

[Association between arterial pressure and other cardiovascular risk factors in adolescence]

A screening for hypertension and other cardiovascular risk factors was carried out during 1981 in a population of 1142 subjects (675 males and 467 females) aged 14-18 years. Aim of the study was to analyze the distribution of blood pressure values and of variables possibly associated with hypertension in a population of adolescents. The mean value of systolic blood pressure was higher in males than in females, slightly increasing with age in males and decreasing in females. The diastolic blood pressure was similar, and increased with age in both sexes. The prevalence of individuals with systolic blood pressure greater than or equal to 140 mmHg resulted of 16.1% in males and of 5.6% in females; the prevalence of adolescents with diastolic blood pressure greater than or equal to 90 mmHg was much lower, being of 2.5% and 1.5% respectively. The average value of heart rate was higher in females and decreased with age in both sexes. Males showed significantly greater height and weight, but the body mass index was nearly equal in the two sexes; females had thicker skinfolds. All these variables only in males were clearly associated with age. Among anamnestic variables, only smoking habits, alcohol consumption and physical activity were significantly different in the two sexes. A positive family history for hypertension was present in 31.4% of the adolescents in whom an objective assessment was possible. In both sexes the systolic blood pressure appeared significantly related to heart rate, body weight, body mass index and skinfold thickness.(ABSTRACT TRUNCATED AT 250 WORDS)A screening for hypertension and other cardiovascular risk factors was carried out during 1981 in a population of 1142 subjects (675 males and 467 females) aged 14-18 years. Aim of the study was to analyze the distribution of blood pressure values and of variables possibly associated with hypertension in a population of adolescents. The mean value of systolic blood pressure was higher in males than in females, slightly increasing with age in males and decreasing in females. The diastolic blood pressure was similar, and increased with age in both sexes. The prevalence of individuals with systolic blood pressure greater than or equal to 140 mmHg resulted of 16.1% in males and of 5.6% in females; the prevalence of adolescents with diastolic blood pressure greater than or equal to 90 mmHg was much lower, being of 2.5% and 1.5% respectively. The average value of heart rate was higher in females and decreased with age in both sexes. Males showed significantly greater height and weight, but the body mass index was nearly equal in the two sexes; females had thicker skinfolds. All these variables only in males were clearly associated with age. Among anamnestic variables, only smoking habits, alcohol consumption and physical activity were significantly different in the two sexes. A positive family history for hypertension was present in 31.4% of the adolescents in whom an objective assessment was possible. In both sexes the systolic blood pressure appeared significantly related to heart rate, body weight, body mass index and skinfold thickness.(ABSTRACT TRUNCATED AT 250 WORDS

[Accuracy of anamnestic data in the definition of the familial history of hypertension]

Positive family history for hypertension (H) in adolescence is a major predictor of development of H in adult life. In epidemiologic studies, family history for H has usually been recorded anamnestically. In the present study, feasibility of the anamnestic data referred by a population of 1142 high school students has been evaluated through the measurement of blood pressure (BP) of their parents. 1519 out of the 2139 eligible (adhesion rate 71.0%) actually attended the visit. Parents were considered to be hypertensive when they were on antihypertensive treatment or when a diastolic BP 65 95 mmHg (average of three readings) was found and confirmed one year later. Definition of the family history for H was possible in the 46.6% of the adolescents on the basis of the anamnestic data, in 64.6% in the basis of the objective ascertainment. The anamnestic data led to an overestimation of positive family history (16.7% vs 9.3% ascertained). Agreement between anamnestic and ascertained family history was very poor (K=0.37). Particularly, 7.8% out of those claimed both the parents had normal BP values, had at least one hypertensive parent; on the contrary, in more than the half of sons (58.9%) with anamnestic positive family history, the objectively recorded BP of parents was normal. The objective definition of family history for H seems to be essential, especially in those studies which include among their goals the evaluation of a positive family history as risk factor for hypertension

Prevalence and variability of orthostatic hypotension in the elderly. Results of the 'Italian study on blood pressure in the elderly (SPAA)'. The 'Gruppo di Studio Sulla Pressione Arteriosa nell'Anziano'

The prevalence of orthostatic hypotension (OH) in an elderly outpatient population was assessed according to the most common criteria given in the literature. Short-term OH variability and relationships between OH and its known risk factors were also analysed. A sample of 3858 elderly outpatients aged 65 years or more was randomly recruited by 444 Italian general practitioners. The patients' blood pressure (BP) and heart rate were recorded in both lying and standing positions at two visits 7 days apart. Three definitions were used for the identification of OH: (1) a decrease in systolic BP greater than 20 mmHg (SOH); (2) a decrease in both systolic (greater than 20 mmHg) and diastolic (greater than 10 mmHg) BP (SDOH); (3) any decrease in systolic BP associated with symptoms (SyOH). Prevalence figures for SOH were 13.8% at the first and 12.6% at the second visit, and respectively 5.3 and 4.8% for SDOH, 14.1 and 11.8% for SyOH. All the criteria were met by less than 2% of subjects at each visit. The diagnosis of OH was confirmed at both visits in 36.3% of cases for SOH, in 25.7% for SDOH, and in 43.9% for SyOH. Each different OH definition identifies a population subgroup characterized by different sets of risk-factors. The presence and prevalence of OH is difficult to define because different people may be identified by the currently accepted criteria or by the same criterion over a short time

The Relationships Between CSR, Good Governance and Accountability in the Economy of Communion (EoC) Enterprises

Different types of companies are strongly involved in pursuing corporate social responsibility (CSR) objectives: a) maximizing the creation of shared value for their owners/shareholders and for their other stakeholders and society at large; and b) identifying, preventing and mitigating their possible adverse impacts (EU, 2011, p. 6, A Modern Understanding of Corporate Social Responsibility). Departing from this premise, the chapter aims to propose a reflection on the new frontiers of CSR and the principles and practices of good governance, that are based on the experience of companies (the EoC enterprises) which can be defined as companies with an "ideal motive" (Molteni, 2009) in that they are the fruit of an ethical substratum, which directs every field of human behavior and, therefore, that economic behavior too(www.eoc-online.org). This experience constitutes the focus of our study, which is based on the empirical analysis of two cases of Italian EoC businesses (Ridix spa and Rainbow Library Engraved in Val d'Arno-Fi) (Lubich, 2001; Baldarelli, 2011) in which the principle of reciprocity(Bruni, 2006) enters as fundamental element of the mission, governance and accountability (Matacena, 2011). Consequently, in the analysis of the afore mentioned cases we will address our attention on the mechanisms (operating procedures, decision-making processes, and the logic of power) relative to the governance, trying to outline how the relationship develops dynamically with the CSR and the communion which is declined in this context as: dialogue, trust and reciprocity. The paper is divided into two main parts. In the first one the theoretical framework is drawn through the analysis of recent European and international guidelines that mark the evolution of the concept and socially responsible practices and of contributions in the literature focused good governance in relation to corporate social responsibility. In the second part the research develops through the qualitative analysis (Yin, 1994; Eisenhardt, &. Graebner, 2007) of the two cases of Italian EoC businesses. The main theme of the analysis is the presence of shared values and the belonging to the EoC project. The comparative perspective in which the cases are presented highlights the different economic results, that are achieved in spite of the same intense application of CSR and the EoC pillars in managing the businesses. On the other hand, in relation to the consistency of the EoC phenomenon, the study contributes to offer insights on the relationships among CSR , governance and accountability and on the coherence of their governance according to the project guidelines(eoc-online.org). This with particular relevance to the following aspects: the enhancement of human labor; the importance of ties and relationships; time dedicated to listening and dialogue; involvement based on trust; attention paid to the competitive logic of the market in order to find the right balance between efficiency and communion; and concern to satisfy clients based on the ability “to put oneself in others’ shoes”. These principles have been promoted, at the same time, by way of the creation of “Schools for Entrepreneurs” and other training initiatives such as EoC commissions at a local, national and international level, which, since 2001, have been aimed teaching entrepreneurs and managers the optimum use of company governance tools and enhancing the exchange of experiences within logic of reciprocal growth (Argiolas et al., 2010; Gold, 2004 , 2010)