Beliefs and preferences regarding biological treatments for severe asthma

Background: Severe asthma is a serious condition with a significant burden on patients' morbidity, mortality, and quality of life. Some biological therapies targeting the IgE and interleukin-5 (IL5) mediated pathways are now available. Due to the lack of direct comparison studies, the choice of which medication to use varies. We aimed to explore the beliefs and practices in the use of biological therapies in severe asthma, hypothesizing that differences will occur depending on the prescribers’ specialty and experience. Methods: We conducted an online survey composed of 35 questions in English. The survey was circulated via the INterasma Scientific Network (INESNET) platform as well as through social media. Responses from allergists and pulmonologists, both those with experience of prescribing omalizumab with (OMA/IL5) and without (OMA) experience with anti-IL5 drugs, were compared. Results: Two hundred eighty-five (285) valid questionnaires from 37 countries were analyzed. Seventy-on percent (71%) of respondents prescribed biologics instead of oral glucocorticoids and believed that their side effects are inferior to those of Prednisone 5 mg daily. Agreement with ATS/ERS guidelines for identifying severe asthma patients was less than 50%. Specifically, significant differences were found comparing responses between allergists and pulmonologists (Chi-square test, p < 0.05) and between OMA/IL5 and OMA groups (p < 0.05). Conclusions: Uncertainties and inconsistencies regarding the use of biological medications have been shown. The accuracy of prescribers to correctly identify asthma severity, according to guidelines criteria, is quite poor. Although a substantial majority of prescribers believe that biological drugs are safer than low dose long-term treatment with oral steroids, and that they must be used instead of oral steroids, every effort should be made to further increase awareness. Efficacy as disease modifiers, biomarkers for selecting responsive patients, timing for outcomes evaluation, and checks need to be addressed by further research. Practices and beliefs regarding the use of asthma biologics differ between the prescriber's specialty and experience; however, the latter seems more significant in determining beliefs and behavior. Tailored educational measures are needed to ensure research results are better integrated in daily practice

Ultrasound Detection of Pneumothorax

Introduction Lung sonography has rapidly emerged as a reliable technique in the evaluation of various thoracic diseases. Accurate diagnosis of a pneumothorax in the management of a critical patient can prevent the life-threatening situation. The aim. This article offers our experience of the use of thoracic ultrasound in the diagnosis of a pneumothorax, reviews the proper techniques used, and highlights its clinical utility. Materials and Methods The study study was carried out between June 2015 and September 2016 year. Lung sonography was performed on 110 patients -89 at the Emergency Department and 21 at the betside due to unstability of the patient. The probe is placed in a sagittal position on the anterior chest wall at about the second intercostal space, in the mid-clavicular line. During ultrasonography, the patient is sitting with arms elevated and the hand positioned behind the neck. A 3.5 MHz linear array transducer is used in all the cases and in some cases a straight linear array high frequency probe (5ndash13 MHz).Results Sixty-five/71.5%/ of all 110 patients, witch can be divided into two broad categories: traumaticnbsp in 59 cases (including iatrogenic) or 6 atraumatic, are with sonographic signs ofnbsp pneumothorax. The patients with confirmed pneumothorax are presented with one or more ultrasound signs- in 45 patients -absence ofnbsp lung sliding, in 32 - lsquobarcodersquo often called the lsquostratosphere signrsquo, in 13- loss of lsquocomet-tail artifactsrsquo, in 34- lsquoA-linesrsquo, 14 with lsquolung-point signrsquo, and in 54 the lsquopower slidersquo with loss of lsquolung pulsersquo. 35 of the patients are treated by VATS complete pleurectomy and 5 patients submitted to VATS pleural abrasion. Conclusionsnbsp Thoracic sonography for the detection of pneumothorax has become a well-established modality in the acute care setting. It is indispensible in the blunt or penetrating chest trauma patient, where the identification of a pneumothorax can prevent life-threatening consequences

A description of Tetraonchus gussevi sp. n.(Monogenea) from trout (Salmo trutta m. fario)

5 pages, 2 figures, 1 table.--160 specimens of trout (Salmo trutta m. fario) were examined in Bulgaria (Shirokolayka River) and 143 specimens of the same host in Spain (Porma River). 4.89% were parazitized with Tetraonchus gussevi sp. n. The intensity of the infection was of 1 to 14 specimens. There are comparative description, sizes and drawings of the new monogenean species.Peer reviewe