Inhaled corticosteroids reduce neutrophilic bronchial inflammation in patients with chronic obstructive pulmonary disease.

Abstract BACKGROUND: Airways inflammation is a feature of chronic obstructive pulmonary disease (COPD), but the role of corticosteroids in the management of clinically stable patients has yet to be established. A randomised controlled study was carried out to investigate the effect of high dose inhaled beclomethasone dipropionate (BDP) administered for two months to patients with stable, smoking related COPD. Sputum induction was used to evaluate bronchial inflammation response. METHODS: 34 patients (20 men and 14 women) were examined on three separate occasions. At the initial clinical assessment (visit 0), spirometry and blood gas analysis were performed. On visit 1 (within one week of visit 0) sputum induction was performed and each patient was randomised to receive either BDP 500 micrograms three times daily (treated group) or nothing (control group). After two months (visit 2), all patients underwent repeat clinical assessment, spirometry, and sputum induction. RESULTS: There were no differences in sputum cell counts between the groups at baseline. After two months of treatment, induced sputum samples from patients in the treated group showed a reduction in both neutrophils (-27%) and total cells (-42%) with respect to baseline, while the control group did not (neutrophils +9%, total cells +7%). Macrophages increased in the treated group but not in the control group. The mean final value of sputum neutrophils was 52% in the treated group and 73.3% in the control group (95% confidence interval (CI) -27.2 to -15.4). The mean final value of sputum macrophages was 35.8% in treated group and 19.3% in control group (95% CI 10.3 to 22.8). The differences between the treated and control groups for neutrophils (-21.3%), macrophages (+16.5%), and total cells (-65%) were significant. Spirometry and blood gas data did not change from baseline in either patient group. CONCLUSIONS: A two month course of treatment with high dose inhaled BDP reduces significantly neutrophil cell counts in patients with clinically stable, smoking related COPD. Further studies on the effectiveness of inhaled steroids in COPD are needed to confirm the clinical importance of this observation

Monitoring the quality of laboraties and the prevalence of resistance to antituberculosis drugs: Italy, 1998-2000

In 1998 a network of 20 regional tuberculosis (TB) laboratories (the Italian Multicentre Study on Resistance to Antituberculosis drugs (SMIRA) network) was established in Italy to implement proficiency testing and to monitor the prevalence of drug resistance nationwide. The network managed 30% of all TB cases reported in Italy each year. The aim of the present report is to describe: 1) the accuracy of drug-susceptibility testing in the network; 2) the prevalence of drug resistance for the period 1998-2000. Data were collected from the network laboratories. Sensitivity to streptomycin and ethambutol increased from the first survey (1998-1999) to the second survey (2000) from 87.7 to 91.9%. Specificity, predictive values for resistance and susceptibility, efficiency and reproducibility were consistent in both surveys. In previously untreated cases, the prevalence of multidrug-resistance was the same in both surveys (1.2%), while a slight decrease from the first to the second survey was observed for monoresistance to rifampicin (from 0.8 to 0.4%) and isoniazid (from 2.9 to 2%,). The significant association found between isoniazid resistance and immigration is a useful indicator for both clinicians managing individual tuberculosis cases and public health services planning control strategies

Il dolore sessuale femminile

L’Autore, dopo aver fatto una carrellata sulle varie classificazioni del dolore sessuale femminile, non dimenticando i testi di riferimento (DSM IV e ICD10), si sofferma sulla complessità dell’eziologia dei quadri patologici ad esso correlati. Auspica un approccio integrato multidisciplinare sia dal punto di vista diagnostico che terapeutico

OBJECTIFICATION AND SEXUAL DYSFUNCTIONS IN MEN

Objective: Objectification theory (Fredrickson, Roberts, 1997) posits that inWestern cultures women are frequently sexually objectified and are subsequently led to internalize an observer’s perspective upon their bodies, which promotes negative emotions about one’s own body, reduces flow experiences, and reduces awareness of internal bodily states. These negative experiences can in turn contribute to the risk for depression, eating disorders and sexual dysfunction. Although the literature regarding the impact of objectification experiences on women is large, the evidence supporting objectification theory in men, in particular regarding sexual dysfunction, is still limited. Considering the possible implications for clinical practice, the aim of the present study is to test the validity of objectification theory in heterosexual men, and its implications in terms of sexual functioning and quality of sexual life. Methods: Participants were recruited through word of mouth and via advertisements posted in public places. Participants completed a demographic information sheet and self-report survey instruments, which were counterbalanced in their order to reduce order effects. In particular, we assessed self-surveillance, self-monitoring during sexual activity, exposure to pornography, and erectile dysfunction and sexual quality. 68 men participated to the survey, with a mean age of 28,29 years (range: 19–44). Results: Using a series of multiple hierarchical regressions, we studied the effects of self-surveillance, body shame, self-surveillance during sexual activity, exposure to pornography, on erectile dysfunctions and sexual quality of life in heterosexual males. Results indicate that body shame and self-surveillance are significantly connected to erectile dysfunctions and quality of sexual life. Conclusion: Clinical implications for treatment and prevention are discussed. Policy of full disclosure: Non

Inhaled corticosteroids reduce neutrophilic bronchial inflammation in patients with chronic obstructive pulmonary disease.

BACKGROUND: Airways inflammation is a feature of chronic obstructive pulmonary disease (COPD), but the role of corticosteroids in the management of clinically stable patients has yet to be established. A randomised controlled study was carried out to investigate the effect of high dose inhaled beclomethasone dipropionate (BDP) administered for two months to patients with stable, smoking related COPD. Sputum induction was used to evaluate bronchial inflammation response. METHODS: 34 patients (20 men and 14 women) were examined on three separate occasions. At the initial clinical assessment (visit 0), spirometry and blood gas analysis were performed. On visit 1 (within one week of visit 0) sputum induction was performed and each patient was randomised to receive either BDP 500 micrograms three times daily (treated group) or nothing (control group). After two months (visit 2), all patients underwent repeat clinical assessment, spirometry, and sputum induction. RESULTS: There were no differences in sputum cell counts between the groups at baseline. After two months of treatment, induced sputum samples from patients in the treated group showed a reduction in both neutrophils (-27\%) and total cells (-42\%) with respect to baseline, while the control group did not (neutrophils +9\%, total cells +7\%). Macrophages increased in the treated group but not in the control group. The mean final value of sputum neutrophils was 52\% in the treated group and 73.3\% in the control group (95\% confidence interval (CI) -27.2 to -15.4). The mean final value of sputum macrophages was 35.8\% in treated group and 19.3\% in control group (95\% CI 10.3 to 22.8). The differences between the treated and control groups for neutrophils (-21.3\%), macrophages (+16.5\%), and total cells (-65\%) were significant. Spirometry and blood gas data did not change from baseline in either patient group. CONCLUSIONS: A two month course of treatment with high dose inhaled BDP reduces significantly neutrophil cell counts in patients with clinically stable, smoking related COPD. Further studies on the effectiveness of inhaled steroids in COPD are needed to confirm the clinical importance of this observation

What women think about menopause: An Italian survey

Introduction: Menopause is a critical period for most women who experience associated symptoms while they are still socially and individually active. Objectives: The objective of this study is to report how Italian women perceive and approach menopause. Materials and methods: A survey of 1028 Italian women aged 45\u201365 years was conducted by the Italian Center for Studies of Social Investments (CENSIS) through anonymous interviews using two methods: CATI (Computer Assisted Telephone Interviewing) and CAWI (Computer Assisted Web Interviewing). Principal outcome measures: Principal outcome measures were women's perceptions and experiences of menopause and its treatments. Results: The global consciousness and understanding of menopause was common (82.8 %) among Italian women and it was usually considered a physiological condition (77 %). Overall, 74.6 % of the sample were postmenopausal. Hot flushes were reported to be the most frequent (37.9 %) and bothersome symptoms (43.1 %) while 12.9 % of the women were asymptomatic. As for menopausal therapies, 24.5 % were on treatment; herbal medications were the most common remedy (63.3 %) whereas 7.6 % of the women took hormone replacement therapy (HRT). About half of the sample (50.4 %) had not sought help from the Italian National Health System (INHS). Medical expertise in the field of menopause was thought to be moderately satisfactory by 54.5 % of the sample. Conclusions: Italian women consider menopause a physiological condition. Most postmenopausal women had experienced symptoms but relied on non-hormonal treatments. The median women's satisfaction with the role of the INHS and medical competence suggests the need to improve current knowledge and awareness concerning menopause