impact of frequency and severity of rhinitis on lung function in children and adolescents without asthma

Introducción. Se han observado alteraciones espirométricas en pacientes con rinitis, sin asma, proporcionales al grado clínico de la rinitis establecido por la guía Allergic Rhinitis and its Impact on Asthma (ARIA). Recientemente se ha validado una nueva clasificación de la rinitis como ARIA modificada (ARIAm), que disocia la forma moderada de la grave. Se desconoce el impacto de la rinitis sobre la función pulmonar considerando su frecuencia y gravedad por separado. Objetivos. Determinar las posibles alteraciones de la función pulmonar y su potencial reversibilidad al broncodilatador en niños y adolescentes con rinitis alérgica y no alérgica sin asma, de acuerdo a su frecuencia (intermitente y persistente) y gravedad (leve, moderada y grave) establecida según ARIAm. Población y métodos. Estudio observacional, analítico de corte transversal, que incluyó pacientes de ambos sexos, entre 5 y 18 años, con rinitis alérgica y no alérgica, sin asma. Se realizó espirometría por curva flujo-volumen y se analizó la existencia de anormalidades en la función pulmonar y la respuesta broncodilatadora en relación con el grado de rinitis por ARIAm ajustando un modelo logístico. Se consideró un valor de p<0,05 para establecer significación estadística. Resultados. Se incluyeron 189 pacientes. En 42 (22,2%) se observó al menos un parámetro alterado en la función pulmonar. Los pacientes con rinitis persistente exhibieron mayor afectación de la función pulmonar que los de grado intermitente (p=0,0257). El defecto funcional fue más frecuente en las formas grave y moderada que en el grado leve (p=0,0052) y fue independiente de la condición de atopia (p=0,1574 para frecuencia y p =0,5378 para gravedad). No se encontró diferencia en la reversibilidad al broncodilatador entre los grupos (p=0,1859 y p=0,0575, respectivamente). Conclusiones. La alteración de la función pulmonar se asoció con rinitis persistente. Fue más prevalente en las formas moderada y grave pero no existieron diferencias significativas entre ambas. El defecto funcional se demostró tanto en rinitis alérgica como no alérgica.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’t a significant difference between them. The functional defect was demonstrated in both allergic and nonallergic rhinitis.Fil: Saranz, Ricardo J.. Universidad Católica de Córdoba. Facultad de Medicina. Clínica Universitaria Reina Fabiola; ArgentinaFil: Lozano, Alejandro. Universidad Católica de Córdoba. Facultad de Medicina. Clínica Universitaria Reina Fabiola; ArgentinaFil: Lozano, Natalia A.. Universidad Católica de Córdoba. Facultad de Medicina. Clínica Universitaria Reina Fabiola; ArgentinaFil: Bovina Martijena, María del Pilar. Universidad Católica de Córdoba. Facultad de Medicina. Clínica Universitaria Reina Fabiola; ArgentinaFil: Sasia, Laura V.. Universidad Católica de Córdoba. Facultad de Medicina. Clínica Universitaria Reina Fabiola; ArgentinaFil: Berardi, Yanina V.. Universidad Católica de Córdoba. Facultad de Medicina. Clínica Universitaria Reina Fabiola; ArgentinaFil: Agresta, María Fernanda. Universidad Católica de Córdoba. Facultad de Medicina; ArgentinaFil: Ianiero, Luciano. Universidad Católica de Córdoba. Facultad de Medicina; ArgentinaFil: Ponzio, Marina Flavia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina. Departamento de Fisiología Humana y Física Biomédica. Cátedra de Fisiología Humana; Argentin

A concept for integrated care pathways for atopic dermatitis-A GA2^{2} LEN ADCARE initiative

Introduction: 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. Methods: 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. Results: 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. Conclusion: 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

Análisis de la citología nasal en niño y adolescentes con rinitis

Antecedentes: El examen de la citología nasal es un método simple que permite diferenciar fenotipos de rinitis desde la perspectiva fisiopatogénica y diagnóstica. Existen controversias sobre la relación entre los grados clínicos de la rinitis y los patrones inflamatorios de la citología nasal.                                                                                                                             Objetivos: Estudiar los patrones de eosinófilos y neutrófilos en la rinitis alérgica (RA) y no alérgica (RNA) y su relación con los grados clínicos de rinitis establecidos por la guía Allergic Rhinitis and its Impact on Asthma (ARIA).Población y métodos: Estudio observacional, analítico de corte transversal, que incluyó pacientes de ambos sexos, entre 5 y 18 años, con RA y RNA. Se estudió la citología nasal de muestras extraídas de la superficie mucosa del cornete inferior con tinción de May Grünwald-Giemsa. Se compararon los patrones inflamatorios entre RA y RNA y en relación a los grados clínicos de rinitis establecidos en la guía ARIA.                                                                         Resultados: Se incluyeron 231 pacientes. Los pacientes con RA exhibieron mayor porcentaje de eosinófilos en secreción nasal que en RNA (p=0,0012) pero no hubo diferencias en el recuento de neutrófilos (p=0,4011). No se observaron diferencias en el número de eosinófilos y neutrófilos entre los grados clínicos de RA (p= 0.7342 y p=0.0797 respectivamente) y RNA (p=0.1010 y p= 0.1422 respectivamente).Conclusiones: El recuento de eosinófilos en la citología nasal fue útil para diferenciar la RA de la RNA pero no ayuda, al igual que el recuento de neutrófilos, a distinguir grados clínicos de RA y RNA establecidos por ARIA.</p

Implementation of an NGS‐based 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