Long-term prediction of adherence to continuous positive air pressure therapy for the treatment of moderate/severe obstructive sleep apnea syndrome

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is a highly effective treatment for obstructive sleep apnea syndrome (OSAS). However, poor adherence is a limiting factor, and a significant proportion of patients are unable to tolerate CPAP. The aim of this study was to determine predictors of long-term non-compliance with CPAP. METHODS: CPAP treatment was prescribed to all consecutive patients with moderate or severe OSAS (AHI ≥15 events/h) (n = 295) who underwent a full-night CPAP titration study at home between February 1, 2002 and December 1, 2016. Adherence was defined as CPAP use for at least 4 h per night and five days per week. Subjects had periodical follow-up visits including clinical and biochemical evaluation and assessment of adherence to CPAP. RESULTS: Median follow-up observation was 74.8 (24.2/110.9) months. The percentage of OSAS patients adhering to CPAP was 41.4% (42.3% in males and 37.0% in females), and prevalence was significantly higher in severe OSAS than in moderate (51.8% vs. 22.1%; p < 0.001; respectively). At multivariate analysis, lower severity of OSAS (HR = 0.66; CI 95 0.46-0.94) p < 0.023), cigarette smoking (HR = 1.72; CI 95 1.13-2.61); p = 0.011), and previous cardiovascular events (HR = 1.95; CI 95 1.03-3.70; p = 0.04) were the only independent predictors of long-term non-adherence to CPAP after controlling for age, gender, and metabolic syndrome. CONCLUSIONS: In our cohort of patients with moderate/severe OSAS who were prescribed CPAP therapy, long-term compliance to treatment was present in less than half of the patients. Adherence was positively associated with OSAS severity and negatively associated with cigarette smoking and previous cardiovascular events at baseline

Simultaneous Contralateral Vestibular Schwannoma and Middle Ear Paraganglioma Tumor

To the best of our knowledge, only 2 cases of a simultaneous contralateral vestibular schwannoma (VS) and middle ear paraganglioma (MEP) have previously been reported in literature. We report the third case observed in a 43-year-old male, who presented with an 11-year history of right-sided hearing loss and a 1-year history of left-sided pulsatile tinnitus. A magnetic resonance imaging (MRI) showed a VS on the right side and computer tomography (CT) identified a Fisch type A1 paraganglioma on the left side. The VS was treated using a translabyrinthine approach and the MEP was kept under radiological observation for 1 year. Due to the growth of the MEP (Fisch type A2), it was treated with excision via a retroauricular approach. Our case was very challenging because there was a different and important pathology on each side, both carrying a risk of deafness as a consequence of the disease and/or the treatments

5-Azacytidine in Chronic Myelomonocytic Leukemia: Case Report and Review of Literature.

Hypomethylating drugs are useful in the management of Myelodysplastic syndromes, but there are only few reports on chronic myelomonocycitic (CMML) leukemia patients. We describe our experience in 3 CMML patients treated with azacitidine. Two patients obtained partial response after 4 treatment cycles with only minor toxicity and are in continuous partial response, with stable peripheral blood counts, at 29 and 30 cycles from treatment start

L’imputabilità dei costi di gestione delle discariche dismesse secondo una recente sentenza della Corte di giustizia: il caso“Malagrotta”

Come si determina il soggetto cui sono imputati i costi di gestione delle discariche di rifiuti dopo che siano state dismesse? La soluzione appare particolarmente delicata nel caso di discariche che erano già attive prima dell'entrata in vigore della direttiva "rifiuti". E' questo il caso della discarica "Malagrotta", la più grande discarica d'Europa che ha accolto per anni tutti i rifiuti del Comune di Roma e dintorni

Biologic therapies and small molecules for the management of non-infectious scleritis: a narrative review

Scleritis refers to a wide spectrum of ocular conditions ranging from mild to sight-threatening scleral inflammation that may compromise visual function and threaten the anatomical integrity of the ocular globe. Most aggressive forms like necrotizing or posterior scleritis are often difficult-to-treat cases, refractory to conventional treatment. The association with systemic diseases, namely rheumatoid arthritis, Sjögren syndrome, granulomatosis with polyangiitis, and relapsing polychondritis, may have prognostic implications as well. A better understanding of the pathogenesis of ocular inflammatory diseases have paved the way to more effective and targeted treatment approaches. In this regard, a growing body of evidence supports the potential role of biologic agents in the management of non-infectious scleral inflammation, either idiopathic or in a background of immune-mediated systemic disorders. Biologic agents such as anti-tumor necrosis factor agents, interleukin-1 and interleukin-6 inhibitors as well as CD20 blockade have displayed promising results. More specifically, several studies have reported their ability to control scleral inflammation, reduce the overall scleritis relapses, and allow a glucocorticoid-sparing effect while being generally well tolerated. Anecdotal reports have also been described with other biologic agents including abatacept, ustekinumab, daclizumab, and alemtuzumab as well as targeted small molecules such as tofacitinib. Further studies are warranted to fully elucidate the role of biologic agents in non-infectious scleritis and investigate specific areas with the aim to administer treatments in the context of personalized medicine. This review summarizes the available data regarding clinical trials, small pilot studies, and real-life experience of the last two decades reporting the use of biologic agents in the management of non-infectious scleritis

Emerging cross-disciplinary profiles: The Geomatic Epidemiologist

Abstract Issue Geographic information systems (GIS) and remote sensing technologies are increasingly used in Public Health epidemiology, showing a great potential in anticipating and responding to actual and future challenges for the public health system and in improving health services' excellence. According to the evidences collected within a wide meta-research carried on of relevant literature ("GIS geographic information system" and "GIS geographic information system and training" on Pubmed; "epidemiologist use of GIS and training" and "epidemiologist use of gis" on Google Scholar),GIS and new sensing technologies are mostly used to: map air and water pollution, map diseases prevalence, predict infection diseases and vector-spread diseases in big areas, study health service coverage and preparedness in emergencies, map cities and study urban health, study climate changes for decision making. Description of the Problem Specific skills and training are required to address the use of GIS and new sensing technologies.The specific aim of our study is to identify the professional profile of a new figure, called 'Geomatic Epidemiologist' and to define its professional and educational standards, as well as the relevant training programs. Results Data collection and analysis of INAPP and ESCO databases about existing professional profiles (starting from 2016) has allowed drafting a first qualification schema and profile. The profile has been defined according to the 4C model (elaborated by Univaq) distinguishing between Hard Skills (technical knowledge and skills),Soft Skills (cognitive, individual and social) and interpersonal behaviors. Conclusions Profile will be validated with relevant stakeholders and Public Health professionals in order to deepen the understanding of the main competences required to study health issues with GIS and related technologies; to this extent, a questionnaire has been elaborated to evaluate relevance, frequency and complexity of each component of the profile Key messages Developing cross-disciplinary profiles, (i.e. the Geomatic Epidemiologist) integrating clusters of competences (holistic approach). Public health research challenges and excellence

Role of adalimumab biosimilar in the treatment of non-anterior uveitis associated with Behçet’s syndrome

Introduction: To evaluate the efficacy of SB5, an adalimumab biosimilar, in the management of Behçet’s syndrome (BS)-related uveitis. Methods: Data from eight BS patients (16 eyes) with active non-anterior uveitis and/or systemic uncontrolled disease or performing non-medical switch to SB5 were retrospectively collected and analyzed. Results: Complete control of uveitis was observed in all 16 eyes without relapses during follow-up. The number of relapses 12 months prior to SB5 initiation and at last follow-up was 100 and 0 per 100 patients/year, respectively (p = 0.010). At baseline, four eyes had active retinal vasculitis, whereas at 3 months and at last follow-up, retinal vasculitis had resolved in all of them (p = 0.018). Median visual acuity did not vary significantly between baseline and last follow-up visit (p = 0.109). No ocular complications emerged during treatment. Conclusions: SB5 is effective in the treatment of BS-related non-anterior uveitis. It reduces uveitis relapses and controls retinal vasculitis while allowing preservation of visual acuity

PVDF/BaTiO3 composite foams with high content of β phase by thermally induced phase separation (TIPS)

Poly(vinylidene fluoride) (PVDF) displays ferroelectric, piezoelectric and pyroelectric behavior and it is widely used in high-tech applications including sensors, transducers, energy harvesting devices and actuators. The crystallization of this polymer into highly polar β phase is desirable but is hard to achieve without applying specific thermo-mechanical treatments. Indeed, fabrication processes directly affect PVDF molecular chain conformation, inducing distinct polymorphs. In this paper, we present the fabrication of PVDF/BaTiO3 composite foams by thermally induced phase separation method (TIPS). Different compositions are tested and characterized. The crystallinity, and in particular the development of electroactive β crystal phase is monitored by FTIR, DSC and XRD measurements. Dielectric properties are also evaluated. It turns out that TIPS is a straightforward method that clearly promotes the spontaneous growth of the β phase in PVDF and its composite foams, without the need to apply additional treatments, and also significantly improves the degree of crystallinity. BaTiO3 content gives additional value to the development of β phase and total crystallinity of the systems. The low permittivity values (between 2 and 3), combined with the cellular morphology makes these materials suitable as lightweight components of microelectronic circuits