Adherence issues related to sublingual immunotherapy as perceived by allergists

Objectives: Sublingual immunotherapy (SLIT) is a viable alternative to subcutaneous immunotherapy to treat allergic rhinitis and asthma, and is widely used in clinical practice in many European countries. The clinical efficacy of SLIT has been established in a number of clinical trials and meta-analyses. However, because SLIT is self-administered by patients without medical supervision, the degree of patient adherence with treatment is still a concern. The objective of this study was to evaluate the perception by allergists of issues related to SLIT adherence. Methods: We performed a questionnaire-based survey of 296 Italian allergists, based on the adherence issues known from previous studies. The perception of importance of each item was assessed by a VAS scale ranging from 0 to 10. Results: Patient perception of clinical efficacy was considered the most important factor (ranked 1 by 54% of allergists), followed by the possibility of reimbursement (ranked 1 by 34%), and by the absence of side effects (ranked 1 by 21%). Patient education, regular follow-up, and ease of use of SLIT were ranked first by less than 20% of allergists. Conclusion: These findings indicate that clinical efficacy, cost, and side effects are perceived as the major issues influencing patient adherence to SLIT, and that further improvement of adherence is likely to be achieved by improving the patient information provided by prescribers. © 2010 Scurati et al, publisher and licensee Dove Medical Press Ltd

Evolving strategies for preserving the pulmonary valve during early repair of tetralogy of Fallot: mid-term results.

BackgroundThe aim of the study was to evaluate our results with pulmonary valve (PV) preservation in selected patients with tetralogy of Fallot (TOF).MethodsFrom January 2007, 69 patients who underwent early transatrial TOF repair were enrolled in the study. The patients were divided into 2 groups: PV preservation by PV annulus balloon dilation (group 1) and PV cusp reconstruction after annular incision (group 2).ResultsThirty-four patients underwent a successful PV annular preservation (49%). Median age at surgery was 113 days (range, 36-521 days) (group-1 vs group-2, P = not significant). Median preoperative PV Z score was −3.15 (range, −0.95 to −5.62) (group-1 vs group-2, P = .03). Median intensive care unit and hospital stays were 3 and 10 days, respectively (group 1 vs group 2, P = not significant). Median follow-up time was 580 days (range, 189-1940 days) (group 1 vs group 2, P = .08). Two patients were reoperated for residual right ventricular outflow tract (RVOT) obstruction (1 in group 1 and 1 in group 2). The remaining patients are alive and well. Median peak RVOT gradient was 25 mm Hg (range, 8-60 mm Hg) (group 1 vs group 2, P = not significant). The degree of PV regurgitation in group 1 was none/mild in 24 patients (80%) and moderate in 6 (20%) and was none/mild in 8 patients (25%), moderate in 11 (34.4%), and severe in 13 (28.6%) in group 2 (P = .001). Median right ventricular fractional area change was 55% (range, 42%-70%) in group 1 and 50% (range, 40%-63%) in group 2 (P = .003).ConclusionsThe integrity and function of the PV can be preserved in selected patients during early repair of TOF by concomitant balloon dilation, leading to a better mid-term right ventricular function

Clinical comparison of oral administration and viscosupplementation of hyaluronic acid (HA) in early knee osteoarthritis

Purpose: Osteoarthritis (OA) is a progressive, chronic and degenerative joint disease characterized by a loss of articular cartilage. Treatment of OA is largely palliative based on nonsteroidal anti-inflammatory drugs, opioids and injections of steroids. Regarding conservative treatment, intra-articular injections of hyaluronic acid (HA) can play a role in early symptomatic knee OA. Materials and methods: Between August 2015 and September 2015, sixty patients (32 males and 28 females) between 40 and 70 years old were randomly allocated into two groups: Half were treated with three weekly intra-articular injections of hyaluronic acid 1.6 % (group A), while the others were treated with Syalox 300 Plus\uae (hyaluronic acid 300 mg + Boswellia serrata extract 100 mg) 1 tab/die for 20 days and afterward Syalox 150\uae (hyaluronic acid 150 mg) 1 tab/die for other 20 days (group B). All patients were evaluated clinically with American Knee Society Score (AKSS) and visual analogue scale (VAS) for the pain before the treatment and after 3 months. Results: AKSS of the patients in both groups was significantly increased by the treatment, and VAS score was significantly reduced. In both groups, two subgroups were created with patients older than 60 years and patients younger than 60 years. Better results are reported in younger patients of group A and older subjects in group B. Conclusions: Despite several limitations, the results of the study have shown that HA injection and oral administration may have beneficial therapeutic effects on patients with early osteoarthritis. Different outcomes in younger and older subject suggested a combined therapy first with local infiltrations and then with oral composition

Cone-beam computed tomography compared to X-ray in diagnosis of extremities bone fractures: A study of 198 cases

CBCT is an imaging technique consisting of X-ray computed tomography, in which the x-rays are divergent, forming a cone. During 2015, a new model of CBCT, New Tom 5G XL (Verona), was used in the Radiology Department of The University of Verona, in collaboration with the Orthopaedics Department. Our study was carried out from October 2015 to October 2016 (198 patients). We compared CBCT with standard x-ray in the diagnosis of foot and anke fractures (and Lisfranc lesions), tibial plateau fractures, wrist and scaphoid fractures, elbow fractures. All patients were analyzed, of which 143 were positive or had documented bone lesions, while 55 were with no fractures seen. Of the 55 negative patients, 19 were considered positive at Standard RX, thus in 34.5% of cases the X-ray Standard examination overestimated the disease (false positive cases). Similarly, of the 143 positive patients, 21 were negative at RX, resulting in 14.6% of false negatives. We can say that if compared to standard X-ray, CBCT has higher sensitivity and specificity in the proper identification and typing of these kind of lesions, with low exposition dose if compared to MDCT. The most common rx-unrecognized fractures were in small bones of carpus and tarsus

Desempenho de clones de seringueira da série IAC 300 selecionados para a região noroeste do Estado de São Paulo Performance of Hevea clones from IAC 300 series selected in the northwestern region of São Paulo State, Brazil

É apresentado o desempenho de 19 novos clones de seringueira [Hevea brasiliensis (Willd. exAdr. de Juss.) Muell. Arg.], resultantes de hibridações conduzidas no Instituto Agronômico e avaliados em experimento de pequena escala, tendo o clone RRIM 600 como testemunha. O experimento em campo obedeceu ao delineamento em blocos ao acaso, com três repetições. Com relação à produção de borracha seca, o clone IAC 40 apresentou a maior média (62,22 g/árvore/sangria) nos três anos de avaliação, seguido pelo IAC 301 (57,67 g/árvore/sangria) e pelo IAC 300 (50,61 g/árvore/sangria), com produções 154%, 138% e 123% superiores em relação ao RRIM 600 (41,04 g/árvore/sangria). Todos os clones selecionados foram vigorosos, com perímetro do caule na abertura do painel variando de 37,81 cm (IAC 317) a 50,90 cm (IAC 315). A porcentagem de plantas aptas a sangria variou de 20,0% (IAC 317) a 100% (IAC 315). Todos os clones apresentaram baixas incidências de quebra pelo vento e de secamento do painel. Não foi detectada nenhuma doença foliar em caráter epidêmico. Dos clones estudados, 15 apresentaram alta resistência à antracnose do painel, e foram superiores ao RRIM 600; os outros cinco apresentaram resistência moderada semelhante ao RRIM 600.<br>The present paper shows the performance of 19 rubber tree [Hevea brasiliensis (Willd. ex Adr. de Juss.) Muell. Arg.] originated from Hevea breeding programme conducted at the Instituto Agronômico de Campinas (IAC) and evaluated in a small scale trial in the northwestern of São Paulo State, Brazil. The old popular clone RRIM 600 of Malaysian origin was used as control. The trial was laid out in a randomized block design with three replications. Concerned to yielding the clone IAC 40 recorded highest yield (62.22 g/tree/tap) over three years of tapping which was followed by IAC 301 (57.67 g/tree/tap) and IAC 300 (50.61 g/tree/tap) yielding 154%, 138% and 123% superior to the control clone and RRIM 600 whereas recorded 41.04 tree/tap. All selected clones were of vigorous growing, with the girth at opening ranging from 37.81 cm for IAC 317 to 50.90 cm for IAC 315 and tappability ranging from 20.0% for IAC 317 to 100% for IAC 315. All the clones experienced low to very low incidence of wind damage. All selected clones showed low to very low incidence of dry trees. Fifteen clones showed high resistance and five presented moderate resistance to anthrachnose panel canker disease similarly to RRIM 600

Desempenho de clones de seringueira de origem amazônica no planalto do Estado de São Paulo Performance of Amazonian rubber tree clones in the plateau region of the State of São Paulo, Brazil

O objetivo deste trabalho foi avaliar a adaptabilidade e expressão fenotípica de caracteres superiores de dez clones amazônicos de seringueira (Hevea spp.) no planalto do Estado de São Paulo em um período de 10 anos, obedecendo ao delineamento de blocos ao acaso com três repetições e parcelas lineares de seis plantas. O clone IAN 3156 foi o mais produtivo, com média de 65,57 g de borracha seca/árvore/sangria, no período de quatro anos, seguido pelo clone RO 45 com 52,29 g de borracha seca/árvore/sangria, enquanto o clone-testemunha, RRIM 600, produziu 41,04 g/árvore/sangria. Todos os clones apresentaram crescimento vigoroso. O perímetro do caule na abertura do painel variou de 37,01 cm (IAN 3193) a 49,41 cm (IAN 4493). A porcentagem de plantas aptas à sangria variou de 30,0% (IAN 3703) a 93,75% (IAN 6323). Exceto os clones IAN 3156 e IAN 4493 com 7,00 mm e 6,32 mm, respectivamente, todos os outros clones apresentaram espessura de casca virgem inferior ao clone RRIM 600, que apresentou 6,18 mm. O clone IAN 3193 apresentou maior incidência de quebra do ponteiro pelo vento. Todos os clones estudados apresentaram baixa incidência de secamento de painel. O bom desempenho dos clones IAN 3156, RO 45, Fx 3899 e IAN 4493 permite que possam ser experimentados em larga escala, envolvendo diferentes ambientes no Estado de São Paulo.<br>The objective of this paper was to evaluate, for a period of 10 years, the adaptability and phenotypic expression of superior characters of 10 clones of rubber tree (Hevea spp.) grown in the plateau of São Paulo State, Brazil. The clones in the field were arranged in a randomized block design with three replicates and six plants per linear plots. The results showed that the clone IAN 3156 recorded highest yield (65.57 g/tree/tap) followed by RO 45 (52.29 g/tree/tap), whereas the control clone RRIM 600 recorded 41.04 g/tree/tap over four years of tapping. All selected clones were vigorous, with girth range at opening varying from 37.01 cm (IAN 3193) to 49.41 cm (IAN 4493). The percentage range of plants able for opening were 30.0% for IAN 3703 to 93.75% for IAN 6323. Except for IAN 3156 with 7.0 mm and for IAN 4493 with 6.32 mm other clones had low thick virgin bark at open compared to the control clone RRIM 600, which recorded 6.18 mm. Concerned to wind damage, except for IAN 3193 all the studied clones experienced low incidence of wind damage. All clones showed low to very low incidence of tree dryness. A complementary evaluation of the best clones (IAN 3156, RO 45, Fx 3899 and IAN 4493) in different environment of the São Paulo State is suggested, to evaluate besides yielding other secondary characters with the purpose of future recommendation of planting material in large scale