47 research outputs found
impact of frequency and severity of rhinitis on lung function in children and adolescents without asthma
Introducci贸n. Se han observado alteraciones espirom茅tricas en pacientes con rinitis, sin asma, proporcionales al grado cl铆nico de la rinitis establecido por la gu铆a Allergic Rhinitis and its Impact on Asthma (ARIA).
Recientemente se ha validado una nueva clasificaci贸n de la rinitis como ARIA modificada (ARIAm), que disocia la forma moderada de la grave. Se desconoce el impacto de la rinitis sobre la funci贸n pulmonar considerando su frecuencia y gravedad por separado.
Objetivos. Determinar las posibles alteraciones de la funci贸n pulmonar y su potencial reversibilidad al broncodilatador en ni帽os y adolescentes con rinitis al茅rgica y no al茅rgica sin asma, de acuerdo a su frecuencia (intermitente y persistente) y gravedad (leve, moderada y grave) establecida seg煤n ARIAm.
Poblaci贸n y m茅todos. Estudio observacional, anal铆tico de corte transversal, que incluy贸 pacientes de ambos sexos, entre 5 y 18 a帽os, con rinitis al茅rgica y no al茅rgica, sin asma. Se realiz贸 espirometr铆a por curva flujo-volumen y se analiz贸 la existencia de anormalidades en la funci贸n pulmonar y la respuesta broncodilatadora en relaci贸n con el grado de rinitis por ARIAm ajustando un modelo log铆stico. Se consider贸 un valor de p<0,05 para establecer significaci贸n estad铆stica.
Resultados. Se incluyeron 189 pacientes. En 42 (22,2%) se observ贸 al menos un par谩metro alterado en la funci贸n pulmonar. Los pacientes con rinitis persistente exhibieron mayor afectaci贸n de la funci贸n pulmonar que los de grado intermitente (p=0,0257). El defecto funcional fue m谩s frecuente en las formas grave y moderada que en el grado leve (p=0,0052) y fue independiente de la condici贸n de atopia (p=0,1574 para frecuencia y p =0,5378 para gravedad). No se encontr贸 diferencia en la reversibilidad al broncodilatador entre los grupos (p=0,1859 y p=0,0575, respectivamente).
Conclusiones. La alteraci贸n de la funci贸n pulmonar se asoci贸 con rinitis persistente. Fue m谩s prevalente en las formas moderada y grave pero no existieron diferencias significativas entre ambas. El defecto funcional se demostr贸 tanto en rinitis al茅rgica como no al茅rgica.Background: Subclinical spirometric abnormalities have been observed in patients with rhinitis without asthma, proportional to the clinical grade established by Allergic Rhinitis and Its Impact on Asthma (ARIA) guideline. Recently has been validated a new criteria of rhinitis classification designed as ARIA modified (ARIAm), which allow to discrimination moderate to severe grades. Rhinitis impact on lung function according to frequency and severity considering separately is unknown.
Objectives: To investigate possible subclinical alterations in lung function and bronchodilator reversibility in children and adolescents with allergic and non-allergic rhinitis without asthma, according to the frequency and severity criteria of rhinitis classified by ARIAm.
Methods: In an observational cross sectional study we included children and adolescents aged 5 to 18 years with symptoms of allergic and non-allergic rhinitis without asthma. Spirometry was performed by flow-volume curve and we analyzed the abnormalities in respiratory function and bronchodilator response in relation to clinical grade of rhinitis by ARIAm using an adjusted logistic model. A p value Results: We studied 189 patients; 42 (22.2%) had some spirometric abnormalities. Patients with persistent rhinitis had greater impairment of lung function compared to intermittently grade (p = 0.0257). The functional defect was more frequent in rhinitis severe and moderate than mild grade (p = 0.0052) and was independent of atopy status both frequency (p = 0.1574) and severity (p=0.5378). There was no difference in bronchodilator reversibility between groups (p = 0.1859 and p = 0.0575 respectively).
Conclusion: Impaired lung function was associated with persistent rhinitis. It was more prevalent in moderate and severe rhinitis, but there wasn鈥檛 a significant difference between them. The functional defect was demonstrated in both allergic and nonallergic rhinitis.Fil: Saranz, Ricardo J.. Universidad Cat贸lica de C贸rdoba. Facultad de Medicina. Cl铆nica Universitaria Reina Fabiola; ArgentinaFil: Lozano, Alejandro. Universidad Cat贸lica de C贸rdoba. Facultad de Medicina. Cl铆nica Universitaria Reina Fabiola; ArgentinaFil: Lozano, Natalia A.. Universidad Cat贸lica de C贸rdoba. Facultad de Medicina. Cl铆nica Universitaria Reina Fabiola; ArgentinaFil: Bovina Martijena, Mar铆a del Pilar. Universidad Cat贸lica de C贸rdoba. Facultad de Medicina. Cl铆nica Universitaria Reina Fabiola; ArgentinaFil: Sasia, Laura V.. Universidad Cat贸lica de C贸rdoba. Facultad de Medicina. Cl铆nica Universitaria Reina Fabiola; ArgentinaFil: Berardi, Yanina V.. Universidad Cat贸lica de C贸rdoba. Facultad de Medicina. Cl铆nica Universitaria Reina Fabiola; ArgentinaFil: Agresta, Mar铆a Fernanda. Universidad Cat贸lica de C贸rdoba. Facultad de Medicina; ArgentinaFil: Ianiero, Luciano. Universidad Cat贸lica de C贸rdoba. Facultad de Medicina; ArgentinaFil: Ponzio, Marina Flavia. Consejo Nacional de Investigaciones Cient铆ficas y T茅cnicas. Centro Cient铆fico Tecnol贸gico Conicet - C贸rdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de C贸rdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina. Universidad Nacional de C贸rdoba. Facultad de Medicina. Departamento de Fisiolog铆a Humana y F铆sica Biom茅dica. C谩tedra de Fisiolog铆a Humana; Argentin
A concept for integrated care pathways for atopic dermatitis-A GA LEN ADCARE initiative
Introduction: The integrated care pathways for atopic dermatitis (AD鈥怚CPs) aim to bridge the gap between existing AD treatment evidence鈥恇ased guidelines and expert opinion based on daily practice by offering a structured multidisciplinary plan for patient management of AD. ICPs have the potential to enhance guideline recommendations by combining interventions and aspects from different guidelines, integrating quality assurance, and describing co鈥恛rdination of care. Most importantly, patients can enter the ICPs at any level depending on AD severity, resources available in their country, and economic factors such as differences in insurance reimbursement systems. Methods: The GALEN ADCARE network and partners as well as all stakeholders, abbreviated as the AD鈥怚CPs working group, were involved in the discussion and preparation of the AD ICPs during a series of subgroup workshops and meetings in years 2020 and 2021, after which the document was circulated within all GALEN ADCARE centres. Results: The AD鈥怚CPs outline the diagnostic procedures, possible co鈥恗orbidities, different available treatment options including differential approaches for the pediatric population, and the role of the pharmacists and other stakeholders, as well as remaining unmet needs in the management of AD. Conclusion: The AD鈥怚CPs provide a multidisciplinary plan for improved diagnosis, treatment, and patient feedback in AD management, as well as addressing critical unmet needs, including improved access to care, training specialists, implementation of educational programs, assessment on the impact of climate change, and fostering a personalised treatment approach. By focusing on these key areas, the initiative aims to pave the way for a brighter future in the management of AD
Definition, aims, and implementation of GA2LEN/HAEi Angioedema Centers of Reference and Excellence
Global 30-day outcomes after bariatric surgery during the COVID-19 pandemic (GENEVA): an international cohort study
An谩lisis de la citolog铆a nasal en ni帽o y adolescentes con rinitis
Antecedentes: El examen de la citolog铆a nasal es un m茅todo simple que permite diferenciar fenotipos de rinitis desde la perspectiva fisiopatog茅nica y diagn贸stica. Existen controversias sobre la relaci贸n entre los grados cl铆nicos de la rinitis y los patrones inflamatorios de la citolog铆a nasal.聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽Objetivos: Estudiar los patrones de eosin贸filos y neutr贸filos en la rinitis al茅rgica (RA) y no al茅rgica (RNA) y su relaci贸n con los grados cl铆nicos de rinitis establecidos por la gu铆a Allergic Rhinitis and its Impact on Asthma (ARIA).Poblaci贸n y m茅todos: Estudio observacional, anal铆tico de corte transversal, que incluy贸 pacientes de ambos sexos, entre 5 y 18 a帽os, con RA y RNA. Se estudi贸 la citolog铆a nasal de muestras extra铆das de la superficie mucosa del cornete inferior con tinci贸n de May Gr眉nwald-Giemsa. Se compararon los patrones inflamatorios entre RA y RNA y en relaci贸n a los grados cl铆nicos de rinitis establecidos en la gu铆a ARIA.聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽聽Resultados: Se incluyeron 231 pacientes. Los pacientes con RA exhibieron mayor porcentaje de eosin贸filos en secreci贸n nasal que en RNA (p=0,0012) pero no hubo diferencias en el recuento de neutr贸filos (p=0,4011). No se observaron diferencias en el n煤mero de eosin贸filos y neutr贸filos entre los grados cl铆nicos de RA (p= 0.7342 y p=0.0797 respectivamente) y RNA (p=0.1010 y p= 0.1422 respectivamente).Conclusiones: El recuento de eosin贸filos en la citolog铆a nasal fue 煤til para diferenciar la RA de la RNA pero no ayuda, al igual que el recuento de neutr贸filos, a distinguir grados cl铆nicos de RA y RNA establecidos por ARIA.</p
Implementation of an NGS鈥恇ased sequencing and gene fusion panel for clinical screening of patients with suspected hematologic malignancies
The diagnosis of hematologic malignancies integrates multiple diagnostic and clinical disciplines. Historically, targeted (single-analyte) genetic testing has been used as reflex to initial prescreening by other diagnostic modalities including flow cytometry, anatomic pathology, and clinical cytogenetics. Given the wide range of mutations associated with hematologic malignancies a DNA/RNA-based NGS panel can provide a more effective and economical approach to comprehensive testing of patients as an initial, tier-1 screen.
Using a cohort of 380 patients, we performed clinical validation of a gene panel designed to assess 40 genes (DNA), and 29 fusion driver genes with over 600 gene fusion partners (RNA), including sample exchange data across three clinical laboratories, and correlation with cytogenetic testing results.
The clinical validation of this technology demonstrated that its accuracy, sensitivity, and specificity are comparable to the majority of targeted single-gene approaches, while assessment of the initial patient cohort data demonstrated a high diagnostic yield of 50.5%.
Implementation of a tier-1 NGS-based protocol for gene panel screening provides a comprehensive alternative to targeted molecular testing in patients with suspected hematologic malignancies, with increased diagnostic yield, scalability, reproducibility, and cost effectiveness, making it ideally suited for implementation in clinical laboratories
A concept for integrated care pathways for atopic dermatitis-A GA 2 LEN ADCARE initiative
The integrated care pathways for atopic dermatitis (AD-ICPs) aim to bridge the gap between existing AD treatment evidence-based guidelines and expert opinion based on daily practice by offering a structured multidisciplinary plan for patient management of AD. ICPs have the potential to enhance guideline recommendations by combining interventions and aspects from different guidelines, integrating quality assurance, and describing co-ordination of care. Most importantly, patients can enter the ICPs at any level depending on AD severity, resources available in their country, and economic factors such as differences in insurance reimbursement systems. The GA 2 LEN ADCARE network and partners as well as all stakeholders, abbreviated as the AD-ICPs working group, were involved in the discussion and preparation of the AD ICPs during a series of subgroup workshops and meetings in years 2020 and 2021, after which the document was circulated within all GAL 2 EN ADCARE centres. The AD-ICPs outline the diagnostic procedures, possible co-morbidities, different available treatment options including differential approaches for the pediatric population, and the role of the pharmacists and other stakeholders, as well as remaining unmet needs in the management of AD. The AD-ICPs provide a multidisciplinary plan for improved diagnosis, treatment, and patient feedback in AD management, as well as addressing critical unmet needs, including improved access to care, training specialists, implementation of educational programs, assessment on the impact of climate change, and fostering a personalised treatment approach. By focusing on these key areas, the initiative aims to pave the way for a brighter future in the management of AD
The valuation of public and private benefits of green roof retrofit in different climate conditions
Green roofs represent a suitable option for industrial buildings refurbishment, providing private and social benefits. Nowadays, in Italy green roof technology is still uncommon, because of high installation cost that drives the choice towards more traditional performing solutions, such as cool roofs (CRs). Thus, a thorough valuation of green roofs benefits in urban contexts is required to encourage their diffusion. This paper aims to valuate private and social costs and benefits generated by extensive green roofs (EGRs) compared with cool roofs in three Italian cities: Trieste, Ancona and Palermo. These contexts are characterized by different Mediterranean climate conditions (North, Centre and South Italy); moreover, residential areas overlooking industrial settlements take place in each of them, so it is possible to hypothesize a potential enhancement of landscape value in these properties, allowing to compare aesthetic benefits due to green roofs upon industrial buildings. The study has been based on literature review and on simulation of energy performances of EGR and CR alternatively considered as refurbishment solution for a reference industrial building taking place in each industrial settlement. For the social side, the externalities deriving from EGRs and CRs, such as aesthetic enhancement, biodiversity preservation and natural habitat provision, carbon reduction, air quality improvement, stormwater control, have been monetized according to available data for the cases of study. The analysis demonstrates that a private investor has a poor convenience to implement EGR rather than CR. On the other, a positive Net Present Value (NPV) derives from social cost-benefit analysis comparing EGR and CR, due to the EGR positive externalities. The valuation of the positive externalities let the calculation of economic incentives amount to promote the diffusion of green roofs in the Mediterranean area. On this basis, an annual reduction of local property tax has been considered as incentive form. Further, a sensitivity analysis with Monte Carlo simulation of both private and social benefits evaluation has been performed for each of three case studies. This technique properly evaluates the final effects on private investments in the presence of random unpredictable variables, depending either on climate conditions or on market observation, that influence their economic affordability. Finally, through the comparison of the three contexts, an overall discussion about of the influence of climate and urban conditions on the economic analysis has been conducte