An unusual presentation of pulmonary lymphoma: When diffuse ground glass opacities can mean anything

Primary lung lymphoma (PLL) is a rare type of lymphoma confined to the lung at the time of diagnosis. Pulmonary diffuse large B cells lymphoma (P-DLBCL) is the second most common type of PLL and it usually appears radiologically as solitary or multiple nodules or areas of consolidation. We present the case of a 63-year-old Caucasian male who developed severe acute respiratory failure and diffuse ground glass opacities (GGO) on chest computerized tomography. Diffuse GGO may be the radiological expression of very different diseases, ranging from infectious processes to interstitial lung diseases (ILDs) and neoplastic diseases. In our case, pneumonia and de novo ILD were initially considered given the symptoms and past medical history. However, bronchoscopy with trans-bronchial biopsies demonstrated the presence of P-DLBCL, despite an unusual radiological presentation and negative cytological analyses on bronchoalveolar lavage. In conclusion, P-DLBCL should be considered among the many differential diagnoses of diffuse GGO

First record of Monodontidae (Cetacea, Odontoceti) in the Mediterranean Basin from the Pliocene sands of Arcille (Grosseto, Tuscany, Italy)

• MSNUP I17602 represents one of the few monodontid skull of early Pliocene age worldwide. • This discovery testifies the presence of a monodontid taxon in the Mediterranean Basin. • The fossil skull shares several characters with the skull of both extant monodontid genera. • Past monodontid species seems to have been adapted to subtropical climate conditions

Chronic infection with non-tuberculous mycobacteria in patients with non-CF bronchiectasis: Comparison with other pathogens

Abstract Introduction The aim of this study is to compare characteristics of non-cystic fibrosis bronchiectasis (NCFBE) patients with chronic infections with non-tuberculous mycobacteria (NTM) versus those with Pseudomonas aeruginosa or other colonizations. Methods This was an observational, perspective study of consecutive NCFBE adult patients attending the outpatient bronchiectasis clinic at the San Gerardo Hospital in Monza, Italy, during 2012 and 2013. Patients with a chronic infection were included in the study and divided into three groups: those with NTM (Group A); those with P. aeruginosa (Group B); and those with other pathogens (Group C). Patients with both NTM and another pathogen were included in Group A. Comparison among the three study groups was performed using X 2 or Fisher exact test for categorical variables or Kruskal–Wallis or Mann–Whitney test for continuous variables. Results A total of 146 patients (median age 67 years, 40% males) were enrolled: 19 belonged to Group A, 34 to Group B and 93 to Group C. Within group A, 6 patients had only NTM isolation, 7 patients had NTM and P. aeruginosa co-infection and 6 patients had NTM plus another pathogen. The most common isolated pathogens among NTM was Mycobacterium avium complex (15 patients, 79%). A total of 4 patients (21%) with NTM were on active treatment. Patients affected by NTM pulmonary infection had a significantly less severe clinical, functional and radiological involvement compared with patients colonized by P. aeruginosa , see Table. Group A (NTM) n = 19 Group B ( P. aeruginosa ) n = 34 Group C (Others) n = 93 p Value ∗ p Value # p Value + Age (years), median (IQR) 70 (64–75) 74 (67–79) 66 (53–72) 0.001 0.172 0.050 Male, n (%) 8 (42) 15 (44) 36 (33) 0.660 – – BMI, median (IQR) 22 (19–26) 24 (21–25) 24 (21–27) 0.352 – – BSI, median (IQR) 5 (4–9) 12 (8.5–16) 5 (3–7) 0.001 0.001 0.090 Bhalla score, median (IQR) 21 (15–34) 36 (30.5–40.5) 16 (10.5–21.5) 0.001 0.016 0.076 Idiopathic etiology, n (%) 8 (42) 11 (32) 37 (40) 0.721 – – Post-infective etiology, n (%) 8 (42) 16 (47) 29 (31) 0.244 – – Exacerbations/y, median (IQR) 1 (0–2) 2 (1.5–3.5) 2 (1–2) 0.040 0.024 0.132 FEV1%, median (IQR) 85 (59.75–109.5) 58.5 (48.25–74) 84 (62–102) 0.002 0.010 0.857 FVC%, median (IQR) 94.5 (70–109.75) 65 (56–81.5) 88 (69.5–101.5) 0.003 0.003 0.270 ∗ Among the three groups: # Group A vs. Group B; + Group A vs. Group C; BMI: Body mass index; BSI: bronchiectasis severity index; y: year. Conclusions Colonization with P. aeruginosa seems to have the highest impact on the clinical, functional and radiological status of patients with NCFBE. No specific characteristics may help to identify NTM versus other pathogen colonizations. Thus, diagnostics for atypical mycobacteria should be performed on all patients with NCFBE, as suggested by recent international guidelines

La educación tecnológica en la producción de alimentos en huertos traspatio y su relación con el desarrollo humano

Backyard gardens have been used to improve living conditions as means of survival. The technological education that is taught in Technical High Schools encourages the practice of backyard gardens, students acquire skills that are useful to develop throughout life, 11 improving their environment and offering them the opportunity to improve their food quality. Food security is a topic that is debated in the international level, looking for the best way to solve the food situation worldwide, poverty continues to grow the same as the population. The way in which the food industry is producing food is alarming, with a questionable quantity and quality of nutrients. It should be noted that this research is qualitative, has an exploratory descriptive scope, the action-research method was used, making a diagnosis, planning, execution and evaluation, applying various techniques such as questionnaires, interviews and work log. Among the results obtained, it was found that backyard gardens produce quality food (size, quantity) compared to those harvested from the fields. The population that lives in rural areas still use the backyard gardens, however the industry leaves the communities without labor, which affects the loss of food traditions and food production. The amount of fresh food that is consumed in the rural area every day is less, it becomes a small city with the arrival of transnational companies. The development of skills of the students is significant to develop throughout their lives. In two square meters of cultivation, 4.5 kg of carrot and 2.5 kg of onion were harvested. The quality and quantity are similar to those harvested in fields. Food costs have increased in recent years, but food accessibility continues to decline. Rural areas lose their eating habits due to the new transnational food chains, the consumption of fresh food is insufficient. Human development cannot be measured only in material things, yet is found in the development of human capacities, these help individuals to improve their environmentLos huertos traspatios se han utilizado para mejorar las condiciones de vida como método de supervivencia. La educación tecnológica que se imparte en las Secundarias Técnicas fomenta la práctica de los huertos traspatio, los estudiantes adquieren habilidades que les son útiles a lo largo de la vida, mejorando su entorno y ofreciéndoles la oportunidad de mejorar su calidad alimentaria. La seguridad alimentaria es un tema que se debate a nivel internacional, el cual busca la manera más adecuada de resolver la situación alimentaria a nivel mundial, lo cierto es que la pobreza continúa creciendo al igual que la población. Es alarmante la forma en que industria alimentaria esta produciendo alimentos, con una dudosa cantidad y calidad de nutrientes. Cabe destacar que esta investigación es de tipo cualitativa, tiene un alcance descriptivo exploratorio, se utilizó el método de investigación- acción, realizando un diagnóstico, una planeación, la ejecución y evaluación, aplicando varias técnicas como cuestionarios, entrevistas y bitácora de trabajo. Dentro de los resultados que se obtuvieron se encontró que en los huertos traspatio se logra producir alimentos de calidad. La población que vive en zonas rurales aún frecuenta el uso del huerto traspatio, sin embargo, la industria deja sin mano de obra a las comunidades, lo cual alimenta la pérdida de tradiciones alimentarias y producción de alimentos. La cantidad de alimentos frescos que se consumen en la zona rural son cada día son menores, ésta se convierte en una ciudad pequeña con la llegada de las empresas trasnacionales. En dos metros cuadrados de cultivo se lograron cosechar 4.5 kg de zanahoria y 2.5 kg de cebolla. La calidad y cantidad son similares a la de los campos. Los costos de los alimentos han incrementado en los últimos años, pero el acceso a ellos continúa a la baja. El desarrollo humano no se alcanza a medir sólo por lo material, el verdadero desarrollo humano lo encontramos en el desarrollo de las capacidades humanas

Interstitial Lung Disease Associated With Autoimmune Rheumatic Diseases: Checklists for Clinical Practice

Background: Interstitial lung diseases (ILDs) are often associated with rheumatic diseases. Their early diagnosis and management are not only difficult, but also crucial, because they are associated with major morbidity and mortality and can be the first cause of death in autoimmune rheumatic diseases (ARDs). Objectives: By using methodologies, such as Nominal Group Technique (NGT) and Delphi Survey, the aims of this study were (1) to measure consensus between pulmonologists, radiologists, and rheumatologists experienced in the management of ARD-ILD; (2) to highlight the importance of a multidisciplinary approach; and (3) to provide clinicians with a practical tool aimed at improving the prompt recognition and follow-up of ILD associated with ARDs and of any possible rheumatic conditions underlying ILD. Results: During the NGT round, the Steering Committee defined 57 statements to be used in the Delphi survey. A total of 78 experts participated in the Delphi survey, namely 28 pulmonologists, 33 rheumatologists, and 17 radiologists. During this round, consensus on agreement was reached in 47 statements, while disagreement was not reached in any statements. A secondary questionnaire was drafted by the Steering Committee to obtain clearer indications on ILD-ARD \u201cred-flags\u201d and follow-up. Delphi Panelists took part also in the second-questionnaire survey. Answers from both surveys were used to draft two checklists of \u201cred flags\u201d sign or symptom suggestive of ILD and ARD, respectively, and two checklists on identification and monitoring of rheumatoid arthritis (RA) and systemic sclerosis (SSc) ILD. Limitations: This study is a consensus work, which cannot produce empiric data, and is limited to the Italian scenario. Conclusions: This work showed a high level of agreement, but also shows some divergent opinions between different experts. This underlines the importance of a multidisciplinary approach. Eventually, we believe the drafted checklists can help clinicians in the diagnosis and follow-up of ILD-ARD

Clinical phenotypes in adult patients with bronchiectasis

Bronchiectasis is a heterogeneous disease. This study aimed at identifying discrete groups of patients with different clinical and biological characteristics and long-term outcomes. This was a secondary analysis of five European databases of prospectively enrolled adult outpatients with bronchiectasis. Principal component and cluster analyses were performed using demographics, comorbidities, and clinical, radiological, functional and microbiological variables collected during the stable state. Exacerbations, hospitalisations and mortality during a 3-year follow-up were recorded. Clusters were externally validated in an independent cohort of patients with bronchiectasis, also investigating inflammatory markers in sputum. Among 1145 patients (median age 66 years; 40% male), four clusters were identified driven by the presence of chronic infection with Pseudomonas aeruginosa or other pathogens and daily sputum: "Pseudomonas" (16%), "Other chronic infection" (24%), "Daily sputum" (33%) and "Dry bronchiectasis" (27%). Patients in the four clusters showed significant differences in terms of quality of life, exacerbations, hospitalisations and mortality during follow-up. In the validation cohort, free neutrophil elastase activity, myeloperoxidase activity and interleukin-1\u3b2 levels in sputum were significantly different among the clusters. Identification of four clinical phenotypes in bronchiectasis could favour focused treatments in future interventional studies designed to alter the natural history of the disease

Positive end expiratory pressure in acute hypoxemic respiratory failure due to community acquired pneumonia: Do we need a personalized approach?

Background. Acute respiratory failure (ARF) is a life-threatening complication in patients with community acquired pneumonia (CAP). The use of non-invasive ventilation is controversial. With this prospective, observational study we aimed to describe a protocol to assess whether a patient with moderate-to-severe hypoxemic ARF secondary to CAP benefits, in clinical and laboratoristic terms, from the application of a positive end expiratory pressure (PEEP) + oxygen vs oxygen alone. Methods. Patients who benefit from PEEP application (PEEP-responders) were defined as those with partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) increase > 20% and/or reduction of respiratory distress during PEEP + oxygen therapy compared to oxygen therapy alone. Clinical characteristics and outcomes were compared between PEEP-responders and PEEP-non responders. Results. Out of 41 patients, 27 (66%) benefit from PEEP application (PEEPresponders), the best response was obtained with a PEEP of 10 cmH2O in 13 patients, 7.5 cmH2O in eight and 5 cmH2O in six. PEEP-responders were less likely to present comorbidities compared to PEEP-non responders. No differences between groups were found in regards to endotracheal intubation criteria fullfillment, intensive care unit admission and in-hospital mortality, while PEEP-responders had a shorter length of hospital stay. Discussion. The application of a protocol to evaluate PEEP responsiveness might be useful in patients with moderate-to-severe hypoxemic ARF due to CAP in order to personalize and maximize the effectiveness of therapy, and prevent the inappropriate PEEP use. PEEP responsiveness does not seem to be associated with better outcomes, with the exception of a shorter length of hospital stay

Characterizing non-tuberculous mycobacteria infection in bronchiectasis

Chronic airway infection is a key aspect of the pathogenesis of bronchiectasis. A growing interest has been raised on non-tuberculous mycobacteria (NTM) infection. We aimed at describing the clinical characteristics, diagnostic process, therapeutic options and outcomes of bronchiectasis patients with pulmonary NTM (pNTM) disease. This was a prospective, observational study enrolling 261 adult bronchiectasis patients during the stable state at the San Gerardo Hospital, Monza, Italy, from 2012 to 2015. Three groups were identified: pNTM disease; chronic P. aeruginosa infection; chronic infection due to bacteria other than P. aeruginosa. NTM were isolated in 32 (12%) patients, and among them, a diagnosis of pNTM disease was reached in 23 cases. When compared to chronic P. aeruginosa infection, patients with pNTM were more likely to have cylindrical bronchiectasis and a “tree-in-bud” pattern, a history of weight loss, a lower disease severity and a lower number of pulmonary exacerbations. Among pNTM patients who started treatment, 68% showed a radiological improvement, and 37% achieved culture conversion without recurrence, while 21% showed NTM isolation recurrence. NTM isolation seems to be a frequent event in bronchiectasis patients, and few parameters might help to suspect NTM infection. Treatment indications and monitoring still remain an important area for future research

Non-specific interstitial pneumonia and features of connective tissue disease: What are the consequences of a different point of view?

Patients with Interstitial Lung Disease (ILD) without a definitive diagnosis of connective tissue diseases (CTD) were historically described as Undifferentiated Connective Tissue Disease (UCTD-ILD). Recently a new classification, Interstitial Pneumonia with Autoimmune Features (IPAF), has been proposed. Aim of this study was to describe the prevalence, clinical characteristics and prognostic factors of UCTD and IPAF subjects in a cohort of Non-Specific Interstitial Pneumonia (NSIP) patients. This retrospective, observational study enrolled 102 adult patients characterized by NSIP pattern on High Resolution Computed Tomography, without a specific diagnosis of CTD. Three groups were identified according to patients’ characteristics: IPAF, UCTD or idiopathic NSIP (iNSIP). Forty percent, 27% and 55% of patients showed diagnostic criteria for IPAF, UCTD and iNSIP, respectively. No significant differences in age, gender, smoking habit, pulmonary function tests and three-year survival rate were observed among study groups. IPAF patients with antisynthetase antibodies positivity, in comparison to IPAF without antisynthetase antibodies positivity, showed more frequently an acute onset (44% vs 9%, p<0.012). The presence of autoimmune features seems not to be associated with better outcomes in NSIP patients. IPAF criteria seem to be more representative than UCTD criteria in identifying patients with autoimmune features. Further studies are needed to verify if IPAF should include patients with positive antisynthetase serology

Risk of Getting COVID-19 in People With Multiple Sclerosis

Background and Objectives Several studies have assessed risk factors associated with the severity of COVID-19 outcomes in people with multiple sclerosis (PwMS). The potential role of disease-modifying therapies (DMTs) and demographic and clinical factors on the risk of acquiring SARS-CoV-2 infection has not been evaluated so far. The objective of this study was to assess risk factors of contracting SARS-CoV-2 infection in PwMS by using data collected in the Italian MS Register (IMSR). Methods Acase-control (1:2) studywas set up. Cases included PwMSwith a confirmed diagnosis ofCOVID-19, and controls included PwMS without a confirmed diagnosis of COVID-19. Both groups were propensity score–matched by the date of COVID-19 diagnosis, the date of last visit, and the region of residence. No healthy controls were included in this study. COVID-19 risk was estimated by multivariable logistic regression models including demographic and clinical covariates. The impact of DMTs was assessed in 3 independent logistic regression models including one of the following covariates: last administeredDMT, previousDMTsequences, or the place where the last treatment was administered. Results A total of 779 PwMS with confirmed COVID-19 (cases) were matched to 1,558 PwMS without COVID-19 (controls). In all 3 models, comorbidities, female sex, and a younger age were significantly associated (p &lt; 0.02)with a higher risk of contractingCOVID-19. Patients receiving natalizumab as last DMT(OR[95%CI]: 2.38 [1.66–3.42], p &lt; 0.0001) and those who underwent an escalation treatment strategy (1.57 [1.16–2.13], p = 0.003) were at significantly higher COVID-19 risk. Moreover, PwMS receiving their last DMT requiring hospital access (1.65 [1.34–2.04], p &lt; 0.0001) showed a significant higher risk than those taking self-administered DMTs at home. Discussion This case-control study embedded in the IMSR showed that PwMS at higher COVID-19 risk are younger, more frequently female individuals, and with comorbidities. Long-lasting escalation approach and last therapies that expose patients to the hospital environment seem to significantly increase the risk of SARS-CoV2 infection in PwMS. Classification of Evidence This study provides Class III evidence that among patients with MS, younger age, being female individuals, having more comorbidities, receiving natalizumab, undergoing an escalating treatment strategy, or receiving treatment at a hospital were associated with being infected with COVID-19. Among patients with MS who were infected with COVID-19, a severe course was associated with increasing age and having a progressive form of MS, whereas not being on treatment or receiving an interferon beta agent was protective